331880594-3-29-2023-18-AS-CNWE-CQDRSK-20230329131653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880594
Report Date: 03/29/2023
Date Signed: 03/29/2023 01:16:57 PM

Document Has Been Signed on 03/29/2023 01:16 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	ASTORIA CARE HOME		FACILITY NUMBER:	331880594
ADMINISTRATOR:	ABRUDAN, TEODOR		FACILITY TYPE:	740
ADDRESS:	74101 PORTOLA POINTE LN		TELEPHONE:	(760) 674-7213
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92211
CAPACITY:	6	CENSUS: 5	DATE:	03/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Ermina Feliciano, Caregiver		TIME COMPLETED:	01:25 PM

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On March 29, 2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by Caregiver, Ermina Feliciano who was informed of the purpose of visit. At the time of visit there was 2 staff and 5 residents present. LPA toured the facility inside and out with Ermina Feliciano.

Tour included:

Kitchen; LPA toured the kitchen. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the number of resident in care. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen cabinet, available only to authorized individuals. Trash can has tight-fitting lid. Dishwasher is used to clean and sanitize dishes. All need appliances were present and shown to be in working condition and clean. The fridge was measured at 35 degrees Fahrenheit and Freezer was measures at -6 degrees Fahrenheit.

Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 75 degrees Fahrenheit.

Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items.

Medications; LPA observed medications were labeled and stored in separate bins inside of a locked kitchen cabinet and are distributed according to physician orders. The first aid kit was complete.

Continue on LIC-809C

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ASTORIA CARE HOME	FACILITY NUMBER: 331880594
	VISIT DATE: 03/29/2023

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Continued from LIC809

Bathroom; LPA toured the hallway bathroom and observed bathroom to be clean and equipped with grab bar and non-slip mat. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 108 degrees Fahrenheit

Bedroom; LPA toured six #6 out of #6 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility. Resident bedroom #2 and #3 has a shared bathroom. LPA observed bathroom to be clean and hot water was measured at 107 degrees Fahrenheit.

Garage and Laundry; LPA tour the laundry room and observed room to be clean, washing machine and dryer are all in good repair and sufficient for approved census. Cleaning supplies are stored away in the laundry room, inaccessible to clients. LPA toured the garage and observed garage to be clean and not cluttered.

Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gates remain unlocked. Facility has a pool, LPA observed the pool to be adequately secured.

Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents.

Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Random staff and residents' records were reviewed. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 11/30/2023.

Interview; Two #2 staff and Three residents were interviewed.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with Administrator, Selina Abrudan on the phone and a copy was provided to Ermina Feliciano.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC809 (FAS) - (06/04)

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