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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005010
Report Date: 04/15/2024
Date Signed: 04/15/2024 11:22:57 AM


Document Has Been Signed on 04/15/2024 11:22 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, LLCFACILITY NUMBER:
347005010
ADMINISTRATOR:ANATOLIY MOLITVENIKFACILITY TYPE:
740
ADDRESS:8731 CENTRAL AVENUETELEPHONE:
(916) 776-6665
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:6CENSUS: 6DATE:
04/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Operations Director, Galina Chikivchuk TIME COMPLETED:
11:30 AM
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On 04/15/24, Licensing Program Analyst (LPA) Bains arrived at the facility to conduct a Case Management visit regarding an incident that occurred on 04/05/24. LPA met with Operations Director, Galina Chikivchuk and explained reason for visit.

The facility submitted an incident report (LIC624) and SOC341 to the Department on 04/08/24. Incident report indicated a staff at the facility slapped a resident while in care on 04/05/24 . During today’s visit, LPA conducted interviews with 6 residents ,3 staff members and reviewed records.

No citations are issued at this time however LPA may return at a later date should additional information be needed or available.

Exit interview conducted and copy of the report was provided.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2024
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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