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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881091
Report Date: 12/06/2024
Date Signed: 12/06/2024 03:28:20 PM

Document Has Been Signed on 12/06/2024 03:28 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:ASTRO CONCEPTS CARE LLCFACILITY NUMBER:
331881091
ADMINISTRATOR/
DIRECTOR:
NATALIE MARCAIDAFACILITY TYPE:
735
ADDRESS:27710 BLUE TOPAZ DR.TELEPHONE:
(323) 217-3261
CITY:MENIFEESTATE: CAZIP CODE:
92585
CAPACITY: 6CENSUS: 4DATE:
12/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:38 PM
MET WITH:ADMINISTRATOR, NATALIE MARCAIDATIME VISIT/
INSPECTION COMPLETED:
03:38 PM
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On December 06, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management health and safety visit and met Administrator, Natalie Marcaida. LPA Mixson introduced herself and explained the purpose of the visit.

LPA Mixson toured the facility, along with Administrator, Natalie Marcaida and made observations pertaining to another matter that CCL was made aware.
There were two staff present and four residents at the time of this case management health and safety visit.

There are no imminent health and/or safety concerns observed at the time of visit. LPA Mixson requested and received pertinent documentation. LPA made record reviews pertaining Staff signing another staff name on the MARS. The review of the records revealed staff have not signed another staff’s name. Additionally, LPA made observations pertaining to all resident medication records. There were no observable issues reviewed currently.

LPA appraised Facility staff files. The records reviewed demonstrated there were no documented white outs or cross outs reviewed at this time. The review of the records included the Medication Administration Records (MARS). Staff writing other staffs names was found to be unsupported. There were no documented incidents that could be determined that any staff initials were written without the staff’s permission.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ASTRO CONCEPTS CARE LLC
FACILITY NUMBER: 331881091
VISIT DATE: 12/06/2024
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LPA Mixson did not observe any health and/or safety hazards inside or outside of the facility at the time of this visit. LPA observed the facility utilities to be operating without issue.

LPA Mixson assessed the available food and observed there was a variety of food types available for the residents in care. The food supply meets the requirement of a two-day supply of perishable food items and a seven-day supply of non-perishable food items. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care. There were no regulation violations observed or cited during this visit.

An exit interview was conducted, and a copy of this report was given to the Administrator, Natalie Marcaida.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
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