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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801010
Report Date: 12/23/2021
Date Signed: 12/23/2021 04:18:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ABSOLUTE RESIDENTIAL CAREFACILITY NUMBER:
425801010
ADMINISTRATOR:YAROSLAV PRYKHITKOFACILITY TYPE:
740
ADDRESS:435 REX PLACETELEPHONE:
(805) 964-1195
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY:6CENSUS: 0DATE:
12/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:N/ATIME COMPLETED:
04:20 PM
NARRATIVE
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On 12/23/21 at 3:00 PM, Licensing Program Analyst (LPA) Toan Luong conducted a Case Management for closure at Absolute Residential Care. Today’s investigation was conducted on-site unannounced.

During the visit, LPA was unable to access the facility as the administrator was not available, and the location had been rented out to a family through Air BNB. LPA provided the family LPA’s business card. LPA received a call from Eda, a host renting out the location. Host explained to LPA that the owner of the property have contracted with the agency that no other occupants are allowed. LPA toured the outside of the facility. Based on interview and outside observation, LPA conclude that there are no care and supervision being provided to elderly resident by the facility.

LPA conducted the Case Management with Administrator Yaroslav Prykhitko over the telephone.

On June 15, 2021, LPA interviewed responsible parties of residents that had resided at the facility in May 2021. Interview reveal that responsible parties were notified the facility will be closing June 1, 2021. LPA obtained a copy of one of the letter dated April 27, 2021 and marked received May, 2021 by the responsible party. Letter states the facility will close June 1, 2021. Letter offered responsible party with assistance in relocating residents. Interviews also reveal that the responsible parties were provided 30 days notice, and an extension was not provided. Interviews also reveals that families were informed resident eviction was result of the facility closing. LPA issued a citation base on Health and Safety Code 1569.682(a)(2) of not providing residents 60 day's notice.

Exit interview conducted and citation issued over the telephone. LPA emailed appeal rights and report emailed to administrator for signature.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan LuongTELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABSOLUTE RESIDENTIAL CARE
FACILITY NUMBER: 425801010
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/24/2021
Section Cited

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1569.682(a)(2)Transfer of resident upon forfeiture of license or change in use of facility....Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction...This requirement is not met as evidenced by:
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Based on interviews, the licensee did not comply with the section cited above, as a letters to responsible parties were given less than 60 days notice of facility closure, which posed a potential health and safety risk to residents in care.
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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.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan LuongTELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:
DATE: 12/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2