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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004767
Report Date: 09/11/2020
Date Signed: 09/11/2020 04:05:16 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:SHELLY YAMASHIROFACILITY TYPE:
740
ADDRESS:1255 BERING STREETTELEPHONE:
(310) 994-9181
CITY:PLACENTIASTATE: CAZIP CODE:
92870
CAPACITY:6CENSUS: 6DATE:
09/11/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Licensee Nico Oudinot and Shelly YamashiroTIME COMPLETED:
03:30 PM
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Licensing Program Manager Luz Adams and Licensing Program Analyst Michelle Reed conducted a Zoom meeting due to COVID-19 and pre-cautionary measures. LPM and LPA identified themselves and discussed the purpose of the call with Licensee Nico Oudinot and Administrator Shelly Yamashiro.

The following regulations were discussed:

1. Section 87405(a)-Administrator Qualifications and Duties-
The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility. Licensee will send a copy of the LIC500 Personnel Report regarding Administrator and staff hours.

2. Section 87468(a)(1)- Personal Rights
All residents in Residential Care Facilities for the Elderly have the right to be accorded dignity in their personal relationships with staff, residents and other persons. Licensee and Administrator understand resident rights.

3. Visiting at the facility during COVID19 and CDC guidelines
Licensee and Administrator would like to have virtual visits per CDC guidelines. A copy of the visiting policies of the facility will be sent to Licensing as well as responsible parties.

An exit interview was conducted with Nicolas Ouidinot and Shelly Yamashiro via zoom 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: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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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