<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005360
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:12:29 AM


Document Has Been Signed on 11/02/2022 11:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ASTORIA SENIOR CARE HOMES AT MONARCH BAYFACILITY NUMBER:
306005360
ADMINISTRATOR:ABRUDAN, OANA MARIAFACILITY TYPE:
740
ADDRESS:32622 AZORES ROADTELEPHONE:
(714) 299-9527
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY:6CENSUS: 5DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Aris Jugo and Oana AbrudanTIME COMPLETED:
10:44 AM
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) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregiver Aris Jugo and explained the reason for the visit. Administrator Oana Abrudan arrived during the visit. Administrator Oana Abrudan has an administrator certificate expiring on 01/07/2023.

At 9:35 AM, LPA toured the facility with Caregiver Jugo. Facility has five residents in care during today's visit, with three on hospice care. LPA observed residents relaxing in the facility. All residents appeared well taken care of. Facility appears clean and sanitary. All resident's rooms had the required elements as well as restrooms stocked with soap/ sanitizer. Hand washing signs are posted throughout the restrooms. LPA observed the screening/ sanitizing station in the entrance of the facility. Facility takes resident and staff temperatures daily and documents. Facility has covid precaution postings as well as required department postings. LPA toured the kitchen and observed ample food supply. All appliances are operational. Facility has completed the mitigation and infection control plan and plans have been approved. LPA observed emergency food, water, and supplies as well as the first aid kit which contained all required items. Smoke/ carbon monoxide detectors are hardwired and tested operational during today's visit. Fire extinguisher is mounted and charged. LPA observed toxins and sharps are inaccessible to residents in care. LPA toured the outside grounds and observed an outside visitation area as well as a fenced and secured pool. Exit gate is unlocked and self latching. Residents participate in activities such as exercise and movies. LPA observed the locked medication storage area. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. All staff and residents are vaccinated for Covid-19. LPA reviewed select resident files which contained all required documentation including emergency information and updated physician reports.
LPA consulted with staff on the importance of maintaining physician orders for bed rails in the resident's file.

No deficiencies noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1