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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700440
Report Date: 11/22/2022
Date Signed: 11/22/2022 12:46:49 PM


Document Has Been Signed on 11/22/2022 12:46 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
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: 6DATE:
11/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Julie NonuTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA)s Jamie Ivey Canady arrived unannounced at the facility on 11/22/2022 to conduct a case management visit due to Plan of Correction and a stipulation order in place for Abounding Love Home Care.

LPAs toured the facility. LPAs observed the stipulation order was posted on a wall in a conspicuous place in the facility. According to the stipulation order, Mike Her, Deborah Saunikalau, and Anthony Camacho are excluded and shall not be on the premises. LPAs did not observe those individuals during the visit. The facility is clean safe and sanitary. All furniture is in good condition. LPA observed there to be no safety hazards on the flooring in the facility. LPA observed 6 residents and 2 staff today.



Per California Code of Regulations Title 22, Division 6 Chapter 8, no deficiencies were observed. Exit interview held and a copy of the report was given to Administrator Julie Nonu.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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