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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006649
Report Date: 11/01/2024
Date Signed: 11/01/2024 04:17:19 PM

Document Has Been Signed on 11/01/2024 04:17 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:ASTORIA SENIOR CARE HOMES CAMEO SHORESFACILITY NUMBER:
306006649
ADMINISTRATOR/
DIRECTOR:		ABRUDAN, OANAFACILITY TYPE:
740
ADDRESS:4545 ORRINGTON RDTELEPHONE:
(714) 299-9527
CITY:CORONA DEL MARSTATE: CAZIP CODE:
92625
CAPACITY: 6CENSUS: 0DATE:
11/01/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Oana Abrudan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On this day, Licensing Program Analysts (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of conducting a pre-licensing inspection. LPA was greeted and granted entry by Oana Abrudan, administrator.

An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on October 14, 2024 for a capacity of six non-ambulatory residents. This is a change of location with six residents already in care and eventually being relocated from licensed location #306004545. Three of the currently admitted individuals are receiving hospice care. The applicant has requested a hospice waiver.

LPA accompanied by administrator toured the physical plant. The facility is a one-level home with a frontyard, backyard and attached garage. There are six private bedrooms with four bathrooms, some which are en-suite. An additional room will be assigned to be a staff/break room. Necessary components of furnishing for all six bedrooms will be transferred from the currently licensed location at Dover Shores. Three bedrooms have already received rental equipment from the residents' respective providers. The supply of linen and bedsheets will also be relocated. The facility used two water heaters. Personal faucets connected to the tank heater measured at 112F while faucets connected to an on-demand heater measured at 108F. Both are within acceptable range per regulations. Suction grab bars and slip mats are in place at the Dover Shores location and will be relocated upon initial licensing. Common living spaces are present and will also be furnished with items present at Dover Shores. Facility is clean, sanitary and free of odors in all areas inspected. Required posted documents are observed to be present.

CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ASTORIA SENIOR CARE HOMES CAMEO SHORES
FACILITY NUMBER: 306006649
VISIT DATE: 11/01/2024
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CONTINUED FROM FORM LIC809
Kitchen equipment is present and operating as required. Sharp items and cleaning supplies are not present yet but will be secured in drawers and cabinets shown to be functional during the visit. A sufficient supply of perishable and non-perishable food will be relocated to the facility prior to the residents' move-in. The centrally stored medication storage will be located in a secure cabinet. The laundry area is located attached to the kitchen. Cleaning supplies will be locked under the sink or above the washer and drier. Sound alarms are present on the ways of egress and verified to be in operation.

Staff and resident records will be transferred from the previously licensed location. LPA provided consultation to licensee on transferring the facility clearance for staff members.

The fire clearance has been obtained on October 30, 2024 and provided to the Department before the pre-licensing visit. All bedrooms are cleared for non-ambulatory residents and one room equipped with a fire door is cleared for a bedridden individual. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional. Fire extinguishers present on the premises are observed to be charged with current maintenance tags. First aid kit will be provided from the Dover Shores location upon completion of the relocation. Proof of liability insurance coverage provided for the current licensed location. Administrator confirmed that their insurance agent guaranteed the transfer of coverage once licensing and move are effective. Telephone service will also be transferred prior to move-in on November 3, 2024.

LPA and licensee toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture including umbrellas will be installed in both the central courtyard and backyard overlooking the ocean. The perimeter gates present on one side of the house are self-latching and can easily be opened in an evacuation. Bodies of water on the premises are confirmed to be adequately fenced in compliance with state and local building codes. There is a small pond near the entrance passageway with fencing and a fully fenced swimming pool in the courtyard.

Component III was waived as the prospective licensee has already been acting as the current facility administrator in addition to operating other licensed locations. This report was reviewed with facility representative and a copy of this report was emailed to the applicant before the conclusion of the visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC809 (FAS) - (06/04)
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