507005604-8-6-2024-27-AS-MJEN-D7VTEK-20240806144005

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 507005604
Report Date: 08/06/2024
Date Signed: 08/06/2024 02:40:20 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/06/2024 02:40 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	ASTORIA AT OAKDALE		FACILITY NUMBER:	507005604
ADMINISTRATOR:	JACQUELINE HERNANDEZ		FACILITY TYPE:	740
ADDRESS:	700 LAUREL AVE		TELEPHONE:	(209) 847-0864
CITY:	OAKDALE	STATE: CA	ZIP CODE:	95361
CAPACITY:	45	CENSUS: 37	DATE:	08/06/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jacqueline Hernandez		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/6/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue an annual inspection. LPA Jensen met with Executive Director Jacqueline Hernandez and explained the purpose of today's visit. LPA Jensen toured the grounds and observed all paths to be free of obstruction. There are shaded areas and patio furniture available for residents to enjoy outdoor activities. There is a separate enclosed area for memory care residents secured by delayed egress. Raised garden beds and other outdoor activity equipment is in place. LPA Jensen observed the outside perimeter wooden fence to require maintenance or replacement in the near future. Technical assistance was provided. LPA Jensen toured the interior of the facility. Adequate lighting and furnishings were observed. Postings for the Ombudsman and abuse reporting were observed in the front entrance. The emergency disaster plan was posted and current. The thermostats were set between 71 degrees Fahrenheit and 73 degrees Fahrenheit for the comfort of the residents. LPA Jensen toured the kitchen. All food is labeled and dated. There is a two day supply of perishable food and a 7 day supply of non-perishable food. Fresh fruit was available. LPA Jensen observed lunch service which consisted of baked beans, ham and zucchini. There was chocolate cookies, and water with fresh orange slices available on stations throughout the hallway. Carpeting in the memory care unit is currently being replaced one room at a time so as not to create a disruption for residents. LPA Jensen numerous activities available for client engagement. An exercise class for residents was being conducted during the course of this visit. All common areas were sanitary and well maintained. LPA Jensen toured the medication room and found it to be compliant. All toxins were observed to be locked and inaccessible to residents in care. No toxins are stored with any food items. All resident rooms were equipped with the required furniture. Continued on LIC 809C....

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ASTORIA AT OAKDALE	FACILITY NUMBER: 507005604
	VISIT DATE: 08/06/2024

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LPA Jensen reviewed 5 staff files that included the files for all care givers present during the course of this inspection. All staff members had criminal background clearance. All training records reviewed were up to date. Technical assistance was provided on training avauilable through the California Department of Aging. All 5 staff files were determined to be complete and in compliance. LPA Jensen reviewed 5 resident files and found them to be complete and in compliance. LPA Jensen interacted with several residents during the course of this inspection and all residents stated they are satisfied with the care being received. The call signal system was activated and found to be in good working order.

The facility maintains emergency lighting. The carbon monoxide detector was tested and found to be in good working order. The fire extinguishers were last serviced in March of 2024 and are in compliance. The Ansul system was last serviced in March of 2024 and is in compliance. The facility has a current infection control plan.

LPA Jensen also provided technical assistance on hospice care, safeguards for personal property and valuables and activities that foster a sense of purpose.

LPA Jensen requested the following documentation be emailed within the next 7 days:
-LIC 500
-current liability insurance

The facility was determined to be in substantial compliance and deficiencies are being cited as a result of this survey. An exit interview was conducted.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024

LIC809 (FAS) - (06/04)

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