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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700187
Report Date: 10/10/2024
Date Signed: 10/10/2024 10:42:42 AM


Document Has Been Signed on 10/10/2024 10:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ALL SEASONS PHEASANT RIDGEFACILITY NUMBER:
342700187
ADMINISTRATOR:MOLITVENIK, ANATOLIYFACILITY TYPE:
740
ADDRESS:8556 PHEASANT RIDGE LANETELEPHONE:
(916) 776-6665
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
10/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Operations Director, Galina Chikivchuk TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Talwinder Bains arrived on 10/10/24 to conduct the annual inspection. LPA met with Operations Director, Galina Chikivchuk (S1) and explained the purpose of today's visit.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed medications of two (2) residents comparing with physician orders and find no errors. LPA reviewed two (2) residents and two (2) staff files and found all required documents.

LPA and S1 toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher was last serviced on 11/16/23 and was ready for emergency use. Hot water temperature was observed to be 112 degrees F, which is within the regulation range of 105-120 degree. Inside temperature was 73 degree F. Facility was clean and well organized. All required postings were observed. Facility is conducting quarterly fire and disaster drill as required.


No deficiencies were observed or cited per Title 22, CCR Regulations during this visit.
Exit interview conducted and copy of this report was provided to S1.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024
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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