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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700499
Report Date: 07/09/2024
Date Signed: 07/09/2024 11:54:17 AM


Document Has Been Signed on 07/09/2024 11:54 AM - 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 IIFACILITY NUMBER:
342700499
ADMINISTRATOR:NONU, JULIEFACILITY TYPE:
740
ADDRESS:3801 LAKE TERRACE DRTELEPHONE:
(916) 547-0206
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:6CENSUS: 5DATE:
07/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Julie NonuTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a quarterly visit. LPA Moleski met with facility administrator Julie Nonu and explained the purpose of the visit.

When LPA Moleski arrived, LPA Moleski observed a resident (R1) stepping outside onto the front patio without shoes or socks on. LPA Moleski observed R1's toenails were exceedingly long and overgrown, and R1's nail beds appeared discolored.

LPA Moleski reviewed four resident files (R1-R4) and two staff files (S1-S2). A fifth resident (R5) did not have a complete file at the facility. S2 did not have a staff file at the facility.

R4 is diabetic and takes injected insulin, according to S1. R4 administers their own injections, according to S1. LPA Moleski reviewed R4's most recent LIC 602, dated from April 2024, and observed that R4's doctor indicated that R4 is not permitted to administer their own injections.

S1 and S2 did not have documentation on file of completing the required 40 hours of initial training within their first four weeks of employment, per HSC Section 1569.625(b)(1). 22 CCR Section 87412(c) states that “Licensees shall maintain in the personnel records verification of required staff training and orientation.” S1's training record showed that an administrator had signed off on 24 hours of initial training, but S1 had not signed anywhere in the training record. S2 had no training documentation on file.

22 CCR Section 87411(c)(4)(C) states that trainings may be conducted by a person with "at least two years of experience in California as an administrator of an RCFE, within the last eight years, and with a record of administering facilities in substantial compliance..." Nonu was subject to a non-compliance conference on 4/23/24, and therefore has been shown to have operated without substantial compliance. Any staff trainings held after that date must be conducted by a person who meets all qualifications per 22 CCR Section 87411(c)(4). [continued on 809-C]
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
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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Document Has Been Signed on 07/09/2024 11:54 AM - 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 II
FACILITY NUMBER: 342700499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2024
Section Cited
HSC
1569.625(b)(1)

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"...training shall consist of 40 hours of training. ...The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment." This requirement was not met as evidenced by:
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Licensee agrees to provide the full 40 hours of initial training for staff by POC due date. Licensee shall provide LPA Moleski training sign-off sheets once completed.
vincent.moleski@dss.ca.gov
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Based on record review, S1 and S2 did not have documentation of 40 hours of training completed within their first four weeks of employment, which poses a potential health and safety risk.
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Type B
07/23/2024
Section Cited
CCR87464(f)(4)

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"(4) Personal assistance and care as needed by the resident..." This requirement was not met as evidenced by:
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Licensee agrees to acquire podiatry services for R1. Licensee agrees to provide LPA Moleski proof of having made an appointment for R1.
vincent.moleski@dss.ca.gov
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Based on observation, R1 was not provided personal assistance as it relates to his feet and/or toenails, which poses a potential health and safety risk.
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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 RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5


Document Has Been Signed on 07/09/2024 11:54 AM - 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 II
FACILITY NUMBER: 342700499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2024
Section Cited
CCR
87506(a)

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"(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff." This requirement was not met as evidenced by:
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Licensee agrees to acquire and complete a full file for R5. Licensee shall send LPA Moleski a scan of the complete file by POC due date.
vincent.moleski@dss.ca.gov
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Based on observation and interview, R5 had no file at the facility, which poses a potential health and safety risk.
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Type B
07/23/2024
Section Cited
CCR87412(a)

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"(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:" This requirement was not met as evidenced by:
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Licensee agrees to acquire and complete a full file for S2 by POC due date. Licensee shall send LPA Moleski a scan of the complete file by POC due date.
vincent.moleski@dss.ca.gov
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Based on record review and observation, S2 did not have a complete personnel file at the facility, which poses a potential health and safety risk.
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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 RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5


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 II
FACILITY NUMBER: 342700499
VISIT DATE: 07/09/2024
NARRATIVE
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LPA Moleski toured the facility with S1 and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 120 degrees Fahrenheit, which is within the required range of 105 and 120 degrees.

LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked closet for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives.

This facility is hereby cited per the applicable 22 CCR and HSC sections. An exit interview was conducted and a copy of this report was left with Nonu. Appeal rights were left with Nonu.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 07/09/2024 11:54 AM - 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 II
FACILITY NUMBER: 342700499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2024
Section Cited
CCR
87628(a)

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"(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident ... is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional." This requirement was not met as evidenced by:
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Licensee agrees to provide a written plan of correction by POC due date.
vincent.moleski@dss.ca.gov
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Based on record review and interview, R4 is not able to administer their own injections, which poses an immediate health and safety risk.
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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 RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5