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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004767
Report Date: 09/03/2020
Date Signed: 09/03/2020 02:29:48 PM

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:ABOVE ALL CARE 2FACILITY NUMBER:
306004767
ADMINISTRATOR:NICOLAS OUDINOTFACILITY TYPE:
740
ADDRESS:1255 BERING STREETTELEPHONE:
(310) 994-9181
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 6DATE:
09/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Nicolas OudinotTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Michelle Reed contacted the facility to commence a Case Management visit via telephone (facetime) due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call with Licensee Nicolas Oudinot. Administrator Shelly Yamashiro was also contacted and made aware of the visit.

On 8/30/20 R1 left the facility with a family member. When R1 returned, R1 was not wearing a mask nor was R1 quarantined. On today's date, LPA did not observe R1 to be wearing a mask. Mr. Oudinot and Administrator were informed that Assisted Living residents should not leave the facility unless the reason is a necessity, such as for a doctor's appointment or scheduled surgery. The resident should then be quarantined upon return as protection for other residents and staff. LPA also discussed the importance of staff wearing masks and social distancing at meal times.

An exit interview was conducted with Nicolas Ouidinot via telephone and a copy of this report was provided to Mr. Qudinot via email. An electronic email read receipt confirms receiving this document.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 748-2936
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2020
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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