306005176-9-4-2024-22-AS-RMRT-D8SQJ2-20240904121202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005176
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:13:24 PM

Document Has Been Signed on 09/04/2024 12:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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 RESIDENCE - CORONA DEL MAR		FACILITY NUMBER:	306005176
ADMINISTRATOR:	SELINA ABRUDAN		FACILITY TYPE:	740
ADDRESS:	3606 CATAMARAN DRIVE		TELEPHONE:	(949) 719-7718
CITY:	CORONA DEL MAR	STATE: CA	ZIP CODE:	92625
CAPACITY:	6	CENSUS: 4	DATE:	09/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Oana Abrudan, Administrator		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Staff #1 at 9am. During today’s visit, LPA met with Oana Abrudan, Administrator. The facility is a single story, six bedroom building with an approved fire clearance of six non-ambulatory residents of which one may be bedridden. The facility has a hospice waiver for two and currently has a census of four residents in care with one on hospice. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors, testing hot water temperature in three of three resident bathrooms, and testing auditory devices on all exits. The hot water temperature measured between 110.3 and 111.2 degrees Fahrenheit and all smoke detectors were operational. The fire extinguisher is charged and was serviced on June 3, 2024. The facility’s last fire drill was conducted on June 10, 2024. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. LPA observed medication storage and reviewed the centrally stored medications. Per review medications are being given as prescribed. LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate which expires on January 7, 2025. (Continued on LIC 809-C)

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie Ruppert	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 RESIDENCE - CORONA DEL MAR	FACILITY NUMBER: 306005176
	VISIT DATE: 09/04/2024

NARRATIVE

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(Continued from LIC 809-D

White touring facility, LPA observed a storage room being used as a caregiver room. Two former front hall closets were converted into another caregiver room. Both rooms were not noted on the facility sketch that was used for fire clearance. An immediate civil penalty was assessed for $500.

The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations.
An exit interview was conducted with Oana Abrudan, Administrator, and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D, LIC 421IM and Appeal Rights.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie Ruppert	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/04/2024 12:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 RESIDENCE - CORONA DEL MAR	FACILITY NUMBER: 306005176
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87202(a)

Fire Clearance

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Licensing Program Analyst (LPA) observation and record review , the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to staff and persons in care.
	POC Due Date: 09/05/2024
	Plan of Correction
1 2 3 4	Administrator ((AD) will work to obtain fire clearance from local fire authority and/or documentation showing clearance with updated facility sketch. AD will immediately move caregivers into vacant resident rooms until resolved. All documentation will be emailed to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie Ruppert	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024

LIC809 (FAS) - (06/04)

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