342700929-2-11-2026-59-AS-LCRR-DSVTPG-20260406145419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700929
Report Date: 02/11/2026
Date Signed: 02/11/2026 04:48:56 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/15/2026 and conducted by Evaluator Michael Hood

COMPLAINT CONTROL NUMBER: 59-AS-20260115091710

FACILITY NAME:	ALL SEASONS HIALEAH		FACILITY NUMBER:	342700929
ADMINISTRATOR:	TOLY MOLITVENIK		FACILITY TYPE:	740
ADDRESS:	8407 HIALEAH WAY		TELEPHONE:	(916) 776-6665
CITY:	FAIR OAKS	STATE: CA	ZIP CODE:	95628
CAPACITY:	6	CENSUS: 3	DATE:	02/11/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Galina Chikivchuk, Operations Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff are mismanaging residents' medications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Operations Director (OD), Galina Chikivchuk, to deliver findings into the complaint allegation listed above.

During the investigation, LPA conducted a medication count, conducted interviews, and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

Allegation: Facility staff are mismanaging residents' medication

** Report continued on 9099-C **

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 59-AS-20260115091710

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ALL SEASONS HIALEAH	FACILITY NUMBER: 342700929
	VISIT DATE: 02/11/2026

NARRATIVE

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On January 22, 2026, LPA conducted a medication count for residents R1, R2, R3, and R4, comparing each resident’s Centrally Stored Medication Form (CSMF) and Medication Administration Record (MAR) with medications centrally stored for the resident. LPA observed one (1) medication for R2 that had one (1) tab over the amount documented. R2's MAR did not indicate any refusals or missed passes of medication. LPA observed one (1) medication for R4 that did not have a documented start date, but appeared to be administered for five (5) days. LPA observed that another bottle of the same medication indicated a start date of five (5) days prior stored in the resident's overflow medications. Count of the ladder bottle was below the amount documented on R4's CSMF. LPA observed two (2) other medications that were over the amount documented on R4's CSMF. LPA observed an influx of bottles located in R4's overflow medications which could have been used over the course of R4's admission, but R4's documentation did not reflect the use of these bottles. Interviews conducted with R2 and R3's authorized representatives indicated that they did not have any concerns regarding medication administration at the facility.

Based on a medication count and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview was conducted. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20260115091710

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ALL SEASONS HIALEAH	FACILITY NUMBER: 342700929
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/27/2026 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (...) by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Facility conducted an inservice with staff regarding medication administration. Facility will also create a plan on how they will ensure that medications are organized and given as prescribed.
	8 9 10 11 12 13 14	Based on medication count and records reviewed, the facility did not ensure that two (2) of four (4) residents were receiving medications as prescribed in accordance with their records, which poses a potential health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14	Facility will submit to LPA information regarding in-service training and plan by POC due date of February 27, 2026.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026

LIC9099 (FAS) - (06/04)

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