<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004470
Report Date: 12/07/2021
Date Signed: 12/07/2021 01:34:48 PM

Document Has Been Signed on 12/07/2021 01:34 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ABERDEEN TERRACEFACILITY NUMBER:
306004470
ADMINISTRATOR:PETER SCHENKELBERGFACILITY TYPE:
740
ADDRESS:25102 VESPUCCI ROADTELEPHONE:
(949) 357-6666
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 6CENSUS: 5DATE:
12/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Peter SchenkelbergTIME COMPLETED:
01:55 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
Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver and LPA explained he nature of the visit. Peter Schenkelberg, Administrator arrived shortly after and met with LPA.

LPA Martinez accompanied by caregiver began the tour of the inside and outside of the facility. There are five residents in care and there is no active covid-19 case in the facility. LPA observed all residents to be in their bedrooms. All residents appeared to be clean and well taken care of. LPA observed a check in station in the main entry of the facility. LPA observed required Department postings, covid-19 precautionary postings and hand washing signs throughout the facility. All restrooms observed to have ample supply of soap and appeared to be clean. LPA inspected residents’ bedrooms and they appeared to be clean and sanitary. All bedrooms observed to have all required components. Residents bedrooms are all private bedrooms with one resident per. Facility is taking temperature to visitors and twice a day daily for residents. Facility is documenting the results. LPA observed the emergency disaster and evacuation plan. Facility has an emergency back-up food supply and warter supply stored in the kitchen and attached garage. LPA observed the facility to have PPE supply thought out the facility and in the attached garage. Facility has a second story and there are no residents residing in the second floor. LPA toured the outside of the facility and observed several seating areas for the resident’s enjoyment. The facility has completed the LIC808 Mitigation plan. The plan was approved by the Department on April 10, 2021.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1