342700440-3-19-2024-27-AS-PLEE-D3HVBM-20240319161745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700440
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:17:53 PM

Document Has Been Signed on 03/19/2024 04:17 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: 4	DATE:	03/19/2024
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Julie Nonu		TIME COMPLETED:	04:30 PM

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Licensing Program Analyst (LPA) Pang Lee arrived at this facility unannounced on 03/19/2024 at 2:00 PM to conduct a case management visit. LPA Lee met with administrator Julie Nonu and explained the purpose of the visit. The purpose of the visit is follow-up two separate case management.

The first case management is to follow up on deficiencies learned during complaint investigation 27-AS-20240110143818. Through the complaint investigation, it was learned that the licensee did not follow the terms and conditions of Hospice Wavier in section #7 where it states, “The licensee will ensure that all hospice care plans are fully implemented by the licensee, facility staff and the hospice(s).” It was learned that facility staff did not follow resident 1 (R1)’s hospice care plan by refusing to give (R1)’s oral Morphine medication to help manage (R1)’s pain. It was learned that two facility staff refused to administer (R1)’s oral Morphine medication due to lack of training and refusing training from a hospice nurse. It was learned that (R1) has only been administered oral PRN Morphine medications when hospice staff visits the facility since live in staff refused to administer (R1)’s oral PRN Morphine medication.

The second case management is to follow-up on information gather during a complaint investigation 27-AS-20230821152623. It was learned that resident 1 (R1) has pressure injuries to (R1)’s right knee and coccyx. It was learned that (R1) was admitted to the facility on 09/07/2023 with no pressure injuries. (R1) was then admitted to hospice care on 09/15/2023. It was also learned that the hospice nurse who conducted (R1)’s wound assessment on 09/15/2023 during resident being admitted to hospice care indicated that (R1) had a closed scab on right lower calf and is 2 by 2 centimeter and that it was not an open wound. The assessment did indicate that (R1) is at risk for pressure ulcer (skin break down) due to resident skin being fragile due to limited mobility and malnourished.

Continued LIC 809-C

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ABOUNDING LOVE HOME CARE	FACILITY NUMBER: 342700440
	VISIT DATE: 03/19/2024

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During today’s visit, LPA Lee collected the following documents: Reposition Turning Schedules and (R1)’s case notes from January 11, 2024, to current. For today’s visit, LPA Lee provided TSP Pressure Injury Guide and RCFE Training Requirements to administrator. LPA Lee will conduct further investigation and follow-up on (R1)’s pressure injuries.

Deficiencies cited on the LIC 809-D, per Title 22 Regulations. An exit interview was conducted with direct care staff Qalo Saurara and a copy of this LIC 809, LIC 809-D and appeal rights was provided to facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/19/2024 04:17 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ABOUNDING LOVE HOME CARE	FACILITY NUMBER: 342700440
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/19/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/29/2024 Section Cited CCR 87405(d)(1)	1 2 3 4 5 6 7	87405(d)(1) Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator shall ensure hospice care plan are follow at all times. On 01/16/2024, facility staff received medication training from an outside vendor.
	8 9 10 11 12 13 14	Based on interviews and records reviewed, administrator did not follow (R1)’s hospice care plan which requires facility staff to administer (R1) oral PRN Morphine medication as needed. Administrator also did not ensure that facility staff had the proper medication training in place to care for hospice resident. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	Administrator will provide CCL with a written declaration stating that he/she has read and understands the Title 22 Regulations by 03/29/2024.
Type A 03/29/2024 Section Cited CCR87633(d)	1 2 3 4 5 6 7	87633(d) Hospice Care of Terminally Ill Residents (d) The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator shall ensure hospice care plan are follow at all times. Licensee will provide CCL with a written declaration stating that he/she has read and understands the Title 22 Regulations by 03/29/2024.
	8 9 10 11 12 13 14	Based on interviews and records reviewed, the facility did not follow (R1)’s hospice care plan which requires facility staff to administer (R1) oral PRN Morphine medication as needed. This poses an immediate health and safety risk to residents in care.	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: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC809 (FAS) - (06/04)

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