306004545-8-31-2023-22-AS-SSAS-CVPQHS-20230915121134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004545
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:19:31 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230828081557

FACILITY NAME:	ASTORIA RETIREMENT AT DOVER SHORES		FACILITY NUMBER:	306004545
ADMINISTRATOR:	OANA ABRUDAN		FACILITY TYPE:	740
ADDRESS:	1412 SANTIAGO DRIVE		TELEPHONE:	(714) 306-2253
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92660
CAPACITY:	6	CENSUS: 5	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Oana Abrudan, administrator (via telephone)		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility failed to provide a refund

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to initiate the investigation into the allegation listed above. LPA was greeted and granted entry by caregiving staff after introducing himself and stating the purpose of the visit. Allegation was presented to staff. Administrator Oana Abrudan was notified of the visit via telephone and spoke with LPA after being detailed the allegation investigated.

LPA accompanied by caregiving staff conducted a tour of the physical plant. LPA requested to review the resident records including admission agreements for five (5) residents in care in addition to prospective resident R1. LPA additionally interviewed administrator via telephone. A conference call with R1's authorized representative was later held at the initiative of Administrator Oana Abrudan. Additional witness interview wi

CONTINUED ON FORM LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230828081557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ASTORIA RETIREMENT AT DOVER SHORES	FACILITY NUMBER: 306004545
	VISIT DATE: 08/31/2023

NARRATIVE

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CONTINUED FROM LIC9099

Regarding the allegation that Facility failed to provide a refund, the following has been concluded: The authorized representative for resident R1 signed an admission agreement on or around June 24, 2023 as demonstrated by time-stamped text message exchanges provided during the investigation. The actual move-in date for R1 was pushed back by approximately two to three weeks until the facility was officially notified on July 24, 2023 that R1 would not be moving into the facility. Following the notification, the authorized representative was provided with a refund check for an amount determined to be pro-rated for the period of time from July 24 until July 31, 2023 as well as a refund of the community fees in the amount determined by the California Code of Regulations Section 87507(g)(5)(E)(2), as extensive pre-admission assessments had been conducted but the resident had not yet physically moved into the facility, as confirmed by interviews conducted and documentation reviewed.

As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. The Department has therefore dismissed the complaint.

A separate Technical Assistance Advisory Note on records requirement was issued to the facility on a separate form LIC9102.

An exit interview was conducted with administrator via telephone and a copy of this report was left at the facility after being signed by staff with the administrator's authorization

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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