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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005360
Report Date:
12/06/2024
Date Signed:
12/06/2024 01:52:27 PM
Document Has Been Signed on
12/06/2024 01:52 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:
ASTORIA SENIOR CARE HOMES AT MONARCH BAY
FACILITY NUMBER:
306005360
ADMINISTRATOR/
DIRECTOR:
ABRUDAN, OANA MARIA
FACILITY TYPE:
740
ADDRESS:
32622 AZORES ROAD
TELEPHONE:
(714) 299-9527
CITY:
DANA POINT
STATE:
CA
ZIP CODE:
92629
CAPACITY:
6
CENSUS:
5
DATE:
12/06/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:
Aries Jugo
TIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analysts (LPAs) Kimberly Lyman and Fred Arias conducted an unannounced Plan of Correction (POC) visit to follow up on citation issued on 11/04/2024. LPAs were greeted and granted entry into the facility and explained the reason for the visit.
*Deficiency cited under Title 22 Regulation 87303(e)(2) pertaining to Water Temperature has been cleared. Water temperature tested at 110 degrees F in facility restrooms..
Licensee has complied with the POC.
Licensee has been advised to maintain compliance in any items previously cited.
Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME
:
Alisa Ortiz
LICENSING EVALUATOR NAME
:
Kimberly Lyman
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/06/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/06/2024
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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