<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700929
Report Date: 04/21/2022
Date Signed: 04/21/2022 05:09:41 PM


Document Has Been Signed on 04/21/2022 05:09 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ALL SEASONS HIALEAHFACILITY NUMBER:
342700929
ADMINISTRATOR:TOLY MOLITVENIKFACILITY TYPE:
740
ADDRESS:8407 HIALEAH WAYTELEPHONE:
(916) 776-6665
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 6DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Emily Schmidt, caregiver and Hayle Zarate, Resident Care Manager TIME COMPLETED:
05:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Emily Schmidt, caregiver and Hayle Zarate, Resident Care Manager and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. LPA observed (3) residents in the common area watching television and (3) residents to be in their rooms. There is currently (1) resident on hospice services.

LPA and House Manager toured the interior and exterior of the facility, including (6) private resident bedrooms with half bath each, (1) shower room, (1) bathroom,, kitchen, common areas, laundry area, mini-salon, staff/break room and garage/storage areas. One side of the facility is used predominantly by residents and the other side by staff. LPA observed all areas toured to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. Inside temperature was observed to be 71* F. Fire extinguisher last serviced 12/14/2021. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. LPA observed separate locked box in refrigerator for medications . First aid kits on site. Exit doors have alarms and fire doors are able to be kept open with self-closing device, per regulation. LPA observed various Covid posters throughout as well as other required postings. Administrator certificate #6024454740 posted- exp 1/23/2023. LPA observed sufficient PPE supply, incontinent products and activities/books. There is (1) outside gate that is unlocked from the inside with an alarm. Discussed vaccination status of residents and staff, maintaining records of visitor vaccination status/testing, and scheduling a second booster shot with resident families. Also discussed N95 FIT testing for staff and recent PINs issued. There were no deficiencies observed during today's inspection.

LPA obtained an updated copy of LIC500 and LIC9020 during today's inspection. LPA requested a current copy of liability insurance be faxed to the Department by 4/28/22. Exit interview.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1