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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700440
Report Date: 02/01/2023
Date Signed: 02/01/2023 06:30:56 PM


Document Has Been Signed on 02/01/2023 06:30 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: 4DATE:
02/01/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Julie NonuTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analysts (LPA) Jamie Ivey Canady and Avelina Martinez arrived at the facility to conduct a case management. LPA's explained the purpose of the visit to Julie Nonu.

The purpose of this visit is to follow up on learned deficiencies during complaint investigation 27-AS-20230127080755. It was learned the facility Administrator found a new room and board placement for resident 1 (R1) and did not discuss the placement with R1's family. Additionally, the Administrator did not ensure R1 was being relocated to licensed care facility. Moreover, the Administrator did not ensure R1's basic care and supervision required care needs were to going to met. Additionally, due to R1's health diagnosis, R1 requires care and supervision at all times.

As a result, An immediate $500 civil penalty shall be assessed on 2/1/2023 based on lack of basic care services to R1. Which posed an immediate threat to the health, safety and personal rights to R1. Violation of California Code of Regulation Section 1569.312.

Furthermore, the facility Administrator shall receive administrator qualification deficiencies due to not having
Title 22 knowledge and inability to conform to the applicable laws, rules and regulations. Also, the Administrator will shall receive a second administrator qualification deficiency for lack of Good character and a continuing reputation of personal integrity. As the, Administrator did not ensure R1's was placed in a healthful and safe licensed care facility.

During this visit, LPAs observed an infestation of cockroaches. The facility will be cited for the infestation.

As a result of this visit, deficiencies can be found on the 809-page. An exit interview was conducted, and a copy of this report was given to the facility
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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 3


Document Has Been Signed on 02/01/2023 06:30 PM - It Cannot Be Edited

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: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2023
Section Cited

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87405 Administrator - Qualifications and Duties (d)(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)...(5) (5) Good character and a continuing reputation of personal integrity. This requirement was not met as evidenced by:
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The Administrator agrees to complete Admin Qualification and Duties training and provide training completion training by POC Date 02/02/2023. All document shall be emailed to LPA by 02/02/2023 by close of business 5 PM.
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Based on interviews the Licensee did not ensure R1 was placed in a licensed care facility. This poses an immediate health and safety risk for persons in care.
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Type A
02/02/2023
Section Cited

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87405 Administrator - Qualifications and Duties(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)....(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by:
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The Administrator agrees to complete Admin Qualification and Duties training and provide training completion training by POC Date 02/02/2023. All document shall be emailed to LPA by 02/02/2023 by close of business 5 PM.
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The Licensee did not follow Title 22 Regulations during the period of placing R1 in a room and board and not confirming the eviction process. This poses an immediate health and safety risk for persons 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: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 02/01/2023 06:30 PM - It Cannot Be Edited

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: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2023
Section Cited

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1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2... This requirement was not met as evidenced by:
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The Administrator agrees to conduct basic services training by POC Date 02/02/2023. Administrator agrees to review Dementia program plan and regulation by POC 02/02/2023. All document shall be emailed to LPA by 02/02/2023 by close of business 5 PM.
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The Licensee did not assist R1 in securing proper help and support before as described in Title 22 Regulations. This poses an immediate health and safety risk for persons in care.
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Type A
02/02/2023
Section Cited

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Maintenance and Operation 87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidence by:
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The Administrator agrees to conduct pest control treatment and provide pest reports by POC Date 02/02/2023. All document shall be emailed to LPA by 02/02/2023 by close of business 5 PM.
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Based on observation, LPA observed an infestation of cockaroches in the facility. This poses an immediate health and safety risk for persons 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: Jamie Ivey-CanadyTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3