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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700851
Report Date: 08/15/2023
Date Signed: 08/15/2023 12:26:15 PM

Document Has Been Signed on 08/15/2023 12:26 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, 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: 6DATE:
08/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Monalisa Legaspi - AdministratorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced Case Management - Incident visit. LPA met administrator and explained purpose of visit.

LPA discussed medical condition(Foley Catheter) with administrator of resident (R1) and what has been completed for condition. A exception was granted for Foley Catheter on December 30, 2022. All services are provided through Veteran's Administration (VA) and resident is currently not on any medications for urinary tract infections (UTI's). R1 has had several UTI's since admission due to Foley catheter and medical conditions. Several Home Health Companies have provided services for R1 at facility twice a week since admission. VA doctor visits R1 approximately one time a month. VA pharmacist also visits R1 approximately one time a month or when necessary.

Staff training was completed in January of 2023 and are aware of what signs or symptoms to look for regarding infections with Foley catheter for R1. Administrator is involved in care of R1 and is in the facility daily. Family members are included for care plan of R1 and any issues which need to be addressed.

LPA found all medical documentation and records of staff sufficient for R1's care.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies are being cited today in violation of California Code of Regulations.

Exit interview held with administrator. A copy of report and LIC 811 - Confidential names was provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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