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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850481
Report Date: 07/09/2024
Date Signed: 07/10/2024 09:03:48 AM

Document Has Been Signed on 07/10/2024 09:03 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ABOVE ALL CARE, LLCFACILITY NUMBER:
425850481
ADMINISTRATOR/
DIRECTOR:		ANDREICHENKO, VIKTORIIAFACILITY TYPE:
740
ADDRESS:4532 NUECES DRIVETELEPHONE:
(805) 403-7455
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY: 6CENSUS: 6DATE:
07/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:49 PM
MET WITH:Viktoriia Andreichenko, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection visit to the above-named facility. Upon arrival, LPA was greeted by Staff 1 (S1) and Staff 2 (S2) and explained the purpose of the visit. Administrator Viktorria Andreichenko arrived at approximately 2:40 PM. At the time of arrival, there were 6 residents in care and 2 staff on duty.
The facility is licensed as a Residential Care Facility for the Elderly (RCFE) with a dementia diagnosis, has a fire clearance for 6 non-ambulatory residents (of which one may be bedridden) and a hospice waiver for 3 residents. Currently there are 2 residents on hospice.
Entrance interview conducted:
A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service.
The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. There is one fire extinguisher on the premises last serviced on 3/22/2024.
Snacks and beverages are available for residents in care upon request. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Cleaning agents and the toxic chemicals are kept in a locked garage.
Sharps are kept in a locked cabinet in the kitchen. At approximately 2:34 pm, LPA observed a pair of scissors in an unlocked closed cabinet. LPA provided technical assistance to S2 to be certain to keep all sharps, including scissors, in the locked cabinet.

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SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
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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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: ABOVE ALL CARE, LLC
FACILITY NUMBER: 425850481
VISIT DATE: 07/09/2024
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 The living room and dining area are neat and clean. The facility maintains a comfortable room temperature. Hallways, bedroom doors and walls are in good repair.
The facility has six (6) bedrooms for a capacity of six residents. Bedroom #1 has a private bathroom. There are three bathrooms available for residents located off the hallways of the facility. All of the bedrooms are furnished with lights and nightstand lamps to provide sufficient lighting.
Residents’ records are complete.
Due to time restraints, LPA will return at a later date to complete the inspection.

Exit interview conducted. No deficiencies noted. Copy of report issued at the time of the visit.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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