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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005604
Report Date: 02/01/2021
Date Signed: 02/22/2021 02:57:27 PM

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 AT OAKDALEFACILITY NUMBER:
507005604
ADMINISTRATOR:LETICIA HIGARESFACILITY TYPE:
740
ADDRESS:700 LAUREL AVETELEPHONE:
(209) 847-0864
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:45CENSUS: 35DATE:
02/01/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Leticia HigaresTIME COMPLETED:
04:18 PM
NARRATIVE
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Licensing Program Analyst (LPA) Albert Johnson contacted the facility to conclude a case management visit via telephone due to COVID-19 and pre-cautionary measures. A telephone call made to this facility on 1/06/2021 and this LPA was able to speak with the facility designated Administrator. Current census was 35 residents.

The department was made aware of two positive results for Staff at Astoria of Oakdale. Staff one (S1) was reported positive on 1/13/2021. The facility reported on 2/1/2021 that S1 started training when positive test received. Did not affect community status and S2 was reported positive on 1/14/2021. The facility reported on 2/1/2021 that the employee had been off prior to testing positive for regular days off and then in quarantine due to potential exposure. Positive test did not affect community status. The department didn't receive a report of these positive individuals and was made aware of the situation by Public health.


The following deficiencies were observed (see LIC 809-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. Exit interview was conducted with Administrator. Copy of the report sent to the Administrator via e-mail with a "read receipt" to verify the LIC 809 and appeal rights were received. Administrator is to print out the report, sign it, and email a signed copy to LPA
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021
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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ASTORIA AT OAKDALE
FACILITY NUMBER: 507005604
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
02/15/2021
Section Cited

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Reporting Requirements: Occurrences, such as epidemic outbreaks...or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate.
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This requirement is not met as evidenced by:
The facility did not submit incident reports of positive Staff to licensing in a timely manner. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Albert JohnsonTELEPHONE: (916) 217-1390
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2021
LIC809 (FAS) - (06/04)
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