342700440-2-1-2023-27-AS-KHOS-CP9MAM-20230221082635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700440
Report Date: 02/01/2023
Date Signed: 02/01/2023 06:32:51 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/27/2023 and conducted by Evaluator Jamie Ivey-Canady

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230127080755

FACILITY NAME:	ABOUNDING LOVE HOME CARE		FACILITY NUMBER:	342700440
ADMINISTRATOR:	NONU, JULIE ADRIANNA		FACILITY TYPE:	740
ADDRESS:	27 TRISTAN CIR		TELEPHONE:	(916) 619-8590
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	6	CENSUS: 4	DATE:	02/01/2023
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Julie Nonu		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Licensee illegally evicted resident

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Jamie Ivey Canady and Avelina Martinez arrived at the facility unannounced to open a complaint and deliver findings. LPA's explained the purpose of the visit to Julie Nonu.

On 2/1/2023 the complaint allegations listed above were investigated. LPAs requested copies of Admission agreement, Pre-Admission appraisal, LIC 602, the eviction letter and any reassessments done for Resident 1 (R1). The facility Staff 1 (S1) confirmed that the R1 was removed from the facility due to needing a higher level of care. S1 also acknowledged no report was given to The Department or Responsible Parties.

Cont on 9099-C
Page 1 of 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 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.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 27-AS-20230127080755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 02/01/2023 Section Cited CCR 87224(c)	1 2 3 4 5 6 7	87224 Eviction Procedures (c) The licensee shall, in addition to either serving the required thirty (30) days notice , sixty (60) days notice or seeking approval from the Department...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agrees to complete eviction procedurestraining and provide training completetion training by POC Date 02/02/2023. All document shall be emailed to LPA by 02/02/2023 by close of business 5 PM.
	8 9 10 11 12 13 14	Based on interviews and record review, The licensee did not ensure the resident was afforded Title 22 rights regarding the eviction process. This poses an immediate health and safety risk for persons in care.	8 9 10 11 12 13 14
Type A CCR	1 2 3 4 5 6 7	:	1 2 3 4 5 6 7
	8 9 10 11 12 13 14		8 9 10 11 12 13 14

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 Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20230127080755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
	VISIT DATE: 02/01/2023

NARRATIVE

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The Department was not notified of the eviction, therefore the allegations Licensee illegally evicted resident is Substantiated.

Based on LPAs observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview with Administrator. Appeal rights and report given.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/27/2023 and conducted by Evaluator Jamie Ivey-Canady

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230127080755

FACILITY NAME:	ABOUNDING LOVE HOME CARE		FACILITY NUMBER:	342700440
ADMINISTRATOR:	NONU, JULIE ADRIANNA		FACILITY TYPE:	740
ADDRESS:	27 TRISTAN CIR		TELEPHONE:	(916) 619-8590
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	6	CENSUS: 4	DATE:	02/01/2023
		UNANNOUNCED	TIME BEGAN:	10:46 AM
MET WITH:	Julie Nonu		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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9

Licensee did not report incident to appropriate parties

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Jamie Ivey Canady and Avelina Martinez arrived at the facility unannounced and explained the purpose of the visit.

According to interviews, facility chart reports and facility incident file, there is no record of incident regarding R1. Therefore the allegation Licensee did not report incident to appropriate parties is Unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was given to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 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.

LIC9099 (FAS) - (06/04)

Page: 4 of 4