342700440-4-9-2024-27-AS-KHOS-D4DMLH-20240416094222

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700440
Report Date: 04/09/2024
Date Signed: 04/09/2024 04:40:12 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
08/21/2023 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20230821152623

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:	04/09/2024
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Julie Nonu		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff gave resident Fentanyl

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 4/9/2024 at 4:30pm to deliver findings for the investigated complaint regarding the above-mentioned allegation.

Resident #1 (R1) was admitted to the hospital on 8-16-2023 due to an altered mental state and discharged on 8-29-2023.

The complaint investigation conducted by Community Care Licensing (CCL) revealed that based on information obtained regarding R1, there is no corroborating evidence to support the allegation.

Several care staff interviews concluded that R1 was not given Fentanyl at any point and that they assisted with only medications prescribed by physicians. R1 denied substance abuse and does not know how Fentanyl was ingested.

Unsubstantiated

Estimated Days of Completion: 190

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230821152623

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: 04/09/2024

NARRATIVE

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Based on the facility’s visitation log, there were no visitors in the facility on the date of the incident, 8-16-2023.

Per hospital medical records, R1’s diagnosis; altered mental status, Schizo affective Disorder, Probable Frontotemporal Dementia, Diabetes Mellitus Type 2, Hypertension, Hypothyroidism, left lower extremity DVT (deep vein thrombosis), history of Methamphetamine abuse, and Physical Debility bed bound at baseline.

Medical records noted that R1’s initial urine analysis tested positive for Fentanyl. However, no Fentanyl was given by facility staff, hospital staff nor Emergency Medical Team’s or any other drug which would have caused R1 to have a false positive. Interviews conducted with other residents revealed they have no complaints regarding the facility and had no knowledge of R1’s condition or care.

Based on interviews and lack of evidence the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies cited. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

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