<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700440
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:04:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240110143818
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:
03/19/2024
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Julie NonuTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have sufficient staff to meet the needs of the residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/19/2024 at 9:31 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA Lee met with direct care staff Qalo Saurara and explained the purpose of the visit. The purpose of this visit is to deliver complaint finding for the allegation above. Direct care staff called administrator Julie Nonu to informed her that CCLD was present. Administrator was in a meeting and stated that she will join the visit after the meeting. At approximately 12:35 PM administrator arrived at the facility and joined the visit. The current census is 4 with 2 facility staff. A brief interview was conducted with administrator, Julie Nonu.

Allegation: The facility does not have sufficient staff to meet the needs of the residents in care.
It was alleged that the facility does not have sufficient staff to meet the needs of the residents in care. This investigation consisted of records reviewed, observations, interviews with staff, residents, nurses, and the resident responsible party. LPA Lee interviewed 3 out of 3 residents who have no concern with facility does not have sufficient staff to meet the needs of the resident in care.
Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (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.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 27-AS-20240110143818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Three staff also deny the allegations. Moreover, the two nurses interviewed had no concerns with the facility not having sufficient staff. (R1)'s responsible party also stated no concerns with facility staffing. Based on observations. During a different complaint visit on 02/06/2024, LPA Lee observed Staff 1 (S1) checking on resident 1 (R1) to see if (R1) was comfortable and then repositioned (R1). LPA Lee also observed (S2) helping (R2) with showering and dressing. Based on LIC 500, record review, (S1) and (S2) are live in staff and their scheduled are from Monday through Sunday from 7:00 AM to 7:00 AM. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited.
A copy of this report was provided, along with Appeal Rights and LIC 811, the Confidential Names List.
Exit interview.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/10/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240110143818

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:
03/19/2024
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Julie NonuTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff refused to administer residents PRN medications.
Facility staff are not trained in medication administering.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/18/2024 at 10:30 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with administrator Julie Nonu and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 4 with 2 facility staff. A brief interview with conducted with administrator.

It was alleged that the facility staff refused to administer residents PRN medications and that the facility staff are not trained in medication administering. This investigation consisted of records reviewed, interviews with staff, residents, nurses, and the resident responsible party. LPA Lee interviewed 3 out of 3 residents and 2 out of 3 residents had no concern with facility staff refusing to administer resident’s medications. Two hospice nurses confirmed that two live in staff refused to administer resident 1 (R1) oral PRN Morphine medication. In addition, staff 1 (S1) and (S2) admitted to refusing to administer (R1) oral PRN Morphine medication.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (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.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20240110143818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Based on record review, (R1) was placed on hospice care on 09/15/2023. (R1) hospice care plan included hospice medications to assist in pain management. Per hospice medication direction, facility staff are to administer 5 mg (0.25 ml) Morphine (Roxanol)- oral solution to (R1) every 1 hour as needed. Moreover, LPA Lee reviewed PRN Medication Administrator Log and there were no record of facility staff administering (R1)’s oral Morphine medication. On 01/11/2024, LPA Lee and ombudsman Suhair Siraj made an unannounced visit to the facility to follow-up on the allegations. It was learned that (S1) and (S2) refused to administer (R1)’s oral PRN Morphine medication since (R1)’s Morphine medication was not in tablet form. It was learned that (S1) and (S2) did not feel comfortable administering (R1)’s oral Morphine since the medication came in syringes. It was also learned that administrator confirmed that (S1) and (S2) did not get trained on how to administer (R1) oral PRN Morphine medication. (S1) and (S2) also admitted to not being trained on how to administer (R1)’s oral PRN Morphine medication.

On 01/04/2024, it was also learned that a hospice nurse offered to train (S1) and (S2) on how to administer (R1)’s oral PRN Morphine medication; however (S1) and (S2) refused to be trained because according to (S1) the hospice nurse had a “bad attitude.” Records reviewed indicate that 2 of 3 staff files reviewed, had no evidence of medication training that was provided to staff prior to staff assisting residents in care with their medication. The investigation also reveals that hospice nurses visits the facility 2 times a week beginning of 11/14/2023, 3 times a week beginning of 12/24/2023 and 7 times a week on 01/07/2024 to help assists with (R1)’s
oral PRN medications since facility staff refused to administer the medication.

As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Qalo Saurara and a copy of this LIC 9099, LIC 9099-D and appeal rights provided to facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240110143818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
87465(a)(4)
1
2
3
4
5
6
7
87465(a)(4) Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(4) The licensee shall assist residents with self administered medications as needed.
This requirement is not meet as evidenced by:
1
2
3
4
5
6
7
Licensee will ensure that all residents receives their PRN medication upon request. License to submit a declaration of understanding of the regulatory requirements for assisting with resident's PRN medication.
8
9
10
11
12
13
14
Based on interviews, and records reviewed, the licensee did not comply with the section cited above. The licensee did not ensure that R1 PRN medications were administered to (R1) upon request.
8
9
10
11
12
13
14
 Submission to the Department is by the POC due date 03/29/2024 by 5:00 PM end of day.
Type A
03/29/2024
Section Cited
HSC
1569.69(a)(2)
1
2
3
4
5
6
7
§1569.69 Employees assisting residents with self-administration of medication; training requirements (a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee... (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training…

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee to ensure staff assisting residents in care with their medications receive necessary training per regulation prior to staff assisting with medication administration. License to submit a declaration of understanding of the regulatory requirements for assisting with resident's medication
8
9
10
11
12
13
14
Based on record review and interview, the licensee did not comply with the section cited. 2 staff files reviewed, there was no evidence of medication training, prior to staff assisting residents in care with their medication which poses an immediate health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
by POC date 03/29/2024 by 5:00 PM end of day. On 01/16/2024. Staff received medication training from an outside vender.
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-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (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
LIC9099 (FAS) - (06/04)
Page: 4 of 5