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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700851
Report Date: 08/02/2022
Date Signed: 08/03/2022 07:57:48 AM

Document Has Been Signed on 08/03/2022 07:57 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ASTORIA GARDENSFACILITY NUMBER:
342700851
ADMINISTRATOR:QUILDILIG, KARENFACILITY TYPE:
740
ADDRESS:8609 BANFF VISTA DRIVETELEPHONE:
(916) 714-8685
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 5DATE:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mona Lisa, AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) R. Campbell conducted an unannounced Annual 1-Year Required visit on this date. LPA met and toured with Administrator, Mona Lisa Silapan. The administrator currently holds a certificate (#6025978740) that expires on 03/23/2023..

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms for residents of which 5 bedrooms are occupied by the residents and there is 1 staff bedroom. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 75 degrees Fahrenheit. . The hot water temperature in the residents’ shared bathroom was measured at 115 degrees Fahrenheit. Night lights are maintained in hallways and passages to nonprivate bathrooms. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of 7-day supply of nonperishable and 2-day of perishable food. All Fire Exits are free of obstacles.
Smoke and Carbon Monoxide alarms were tested. Fire Extinguisher was last checked at 02/03/2022.

No deficiencies were cited during this inspection.
Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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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