342700440-11-6-2023-27-AS-PLEE-CXBT5A-20231106132512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700440
Report Date: 11/06/2023
Date Signed: 11/06/2023 01:25:34 PM

Document Has Been Signed on 11/06/2023 01:25 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

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: 5	DATE:	11/06/2023
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	12:07 PM
MET WITH:	Qalo Saurara and Akuila Saukuru		TIME COMPLETED:	01:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Pang Lee arrived at the facility on 11/06/2023 at 12:05 PM to conduct an unannounced Plan of Correction (POC) visit. LPA Lee was greeted by care staff, Qalo Saurara and Akuila Saukuru and asked to call the Facility Designated Administrator, Julie Adriana to let her know that CCL was present at this time. LPA Lee was informed that facility designated administrator could not make the visit and asked LPA to continue the visit with care staff. The current Census is 5 with 2 staff present in the facility.

LPA explained the purpose of the visit. The purpose of this visit is to follow-up on a plan of correction that was due 10/13/2023 and 10/19/2023. Administrator, Julie Adriana sent pictures of POC; however, LPA Lee needed to conduct a POC visit to ensure that all the glasses found on the ground has all been removed. During today's visit, LPA Lee toured and inspected the facility to ensure the deficiency previously cited on 10/12/2023 have been corrected.

LPA reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.

Based upon this inspection, LPA Lee observed the following:

1. Deficiency cited under Title 22 Regulation 80087(a) has been cleared. The license complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee.

2. Deficiency cited under Title 22 Regulation 87303(a) has been cleared. The license complied with the terms of the POC by POC due date.

The administrator complied with the terms of the POC by POC due date. Facility was provided with POC cleared letter. Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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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