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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700440
Report Date: 04/02/2021
Date Signed: 04/02/2021 02:55:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ABOUNDING LOVE HOME CAREFACILITY NUMBER:
342700440
ADMINISTRATOR:NONU, JULIE ADRIANNAFACILITY TYPE:
740
ADDRESS:27 TRISTAN CIRTELEPHONE:
(916) 619-8590
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 5DATE:
04/02/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Rebecca GomezTIME COMPLETED:
12:15 PM
NARRATIVE
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During a visit on 04/02/2021, Licensing Program Analyst (LPA) Suong Teh and LPA Christina Valerio arrived at the facility @~10:35 am. Staff Rebecca greeted LPA Teh and LPA Valerio and allowed LPAs to enter the facility. Staff Rebecca did not screen LPAs by checking LPAs temperatures and asked the protocol COVID 19 questionnaires. LPAs observed that the facility is being painted inside and most of all the posters and pictures are down. However, LPAs did not observe any hand wash station near the front entrance. LPAs observed the front entrance alarm was turned off. Staff Mike Herr arrived to the facility shortly. Mike stated that the facility administrator Julie Nonu is off today.

Due the visit there was computer issued LPAs was not able to complete the report at the facility. However, the report was discussed with staff Mike Herr.

The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. A copy of this report has been emailed to the facility and the administrator was advised that a signed copy of this report shall be emailed to LPA.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2021
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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ABOUNDING LOVE HOME CARE
FACILITY NUMBER: 342700440
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/03/2021
Section Cited

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87705(j)Care of Persons with Dementia
The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.
This requirement is not met as evidenced by: Based on observation and interviews, staff Rebecca Gomez admitted the front alarm was turned off by Resident #1 (R1). This poses a potential health risk to the residents in care.
Type A
04/03/2021
Section Cited

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87211(a)(2) Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:
(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate
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This requirement is not met as evidenced by: Based on the observation interview, LPAs observed no posture signs regarding COVID-19 outside on the front door entrance. Administrator Rebecca Gomez did not screen LPAs upon entering facility by taking temperature, which pose a potential health risk to the resident 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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2021
LIC809 (FAS) - (06/04)
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