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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700929
Report Date: 04/17/2024
Date Signed: 04/17/2024 02:16:08 PM


Document Has Been Signed on 04/17/2024 02:16 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 4DATE:
04/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Toly Molitvenik, AdministratorTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Toly Molitvenik, to conduct an unannounced case management visit on 4/17/2024 to confirm orders to individual for immediate exclusion from all facilities.

LPA served order of immediate exclusion effective 4/17/2024 and explained the "Immediate Exclusion" notice indicating that staff member (S1) cannot be allowed to work, be present, and/or live in a CCL licensed facility, or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow S1 to be physically present in the facility. Administrator indicated they understood the notice and confirmed that S1 is currently not working at the facility.

Exit interview completed. Copy of report was provided to the facility. Signature on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
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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