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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000889
Report Date: 09/27/2024
Date Signed: 09/27/2024 12:13:08 PM

Document Has Been Signed on 09/27/2024 12:13 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SENIOR LIVING COMMUNITY FOR THE EASTERN STAR IN CAFACILITY NUMBER:
306000889
ADMINISTRATOR/
DIRECTOR:		KAT FARRISFACILITY TYPE:
741
ADDRESS:16850 E. BASTANCHURY ROADTELEPHONE:
(714) 577-9281
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 76CENSUS: 32DATE:
09/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Kat FarrisTIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On September 27, 2024, at 8:00am Licensing Program Analyst (LPA) Edward Kim conducted an unannounced Case Management Visit to follow-up on a Report of Suspected Dependent Adult/Elder Abuse (SOC341) received on September 20, 2024 pertaining Resident #1 (R1) regarding an incident where staff were rough handling R1 during transfers. LPA Kim was greeted and granted entry by staff. LPA Kim explained the purpose of the visit to Executive Director Kat Farris.

During today’s visit, LPA toured the interior and exterior of the facility. Residents in care appeared to be safe; no imminent health/safety concerns were observed. LPA Kim inspected the indoor and outdoor of physical plant with ED Farris. No health/safety hazards were observed. Facility was maintained at a comfortable temperature for the residents in care. Thirty-two residents are currently living and present at the facility. Twenty-one staff members are also present at the facility. Residents at facility were observed to be clean and well groomed. LPA inspected facility food supplies. Food supplies were observed to be sufficient at the time of the inspection.

LPA Kim obtained R1's records which includes the Physician's Report, Emergency Information, and Appraisal and Needs Services plan. LPA Kim conducted four (4) resident interviews and five (5) staff interviews. Based on LPA's observations there were no signs of injury on R1. Interviews conducted with four out of four residents and five out of five staff did not corroborate the alleged incident.

Therefore, no deficiencies are cited during this visit.

An Exit interview was conducted, and a copy of this report was provided to the Executive director Kat Farris.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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