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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700499
Report Date: 06/13/2024
Date Signed: 07/01/2024 12:00:20 PM

Substantiated


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
03/13/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240313114254
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: 4DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Julie NonuTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mishandled a resident's personal belongings
Staff mishandled a resident's medications
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski spoke with facility administrator Julie Nonu over the phone and explained the purpose of the visit. Nonu said staff member Moria Gaunavou could sign this report in her absence.

This investigation consisted of interviews, observation, and record review. LPA Moleski interviewed Nonu, a former resident’s responsible party (R1’s RP), two staff members of this facility and one staff member of a separate facility (S1-S3).

R1 was admitted to this facility on 12/29/23. R1 was admitted to a hospital as of 1/30/24. Arrangements were made to have R1 transferred to a separate facility, where R1 was admitted as of 2/27/24.
[continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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 6
Control Number 27-AS-20240313114254
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 II
FACILITY NUMBER: 342700499
VISIT DATE: 06/13/2024
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
In an interview, R1’s RP said that R1’s belongings, including clothing and medications, were not immediately transferred to R1’s new placement, and said that some of R1’s clothes were not delivered at all. LPA Moleski visited Abounding Love II on 3/18/24, and observed that R1’s belongings were no longer present. In an interview, Nonu said that R1 was initially supposed to be moving to a certain facility, but in actuality, R1 did not move there and moved to a second facility. Nonu said that R1’s belongings, including clothing and medications, were sent to the first facility. Nonu said the administrator of the first facility was asked to transfer the items to the second facility, where R1 was moving in. Nonu said a staff member of Abounding Love II (S2) had made the arrangements for the transfer of belongings.

In an interview, S1 said that S1 had packed up R1’s clothes to have them sent out to R1’s new placement. S1 said that R1 was initially supposed to be going to a certain facility, but in actuality moved into another facility. S1 said R1’s clothes were sent to the first facility initially, not the facility where R1 actually moved in. S1 was not sure when the clothes were sent. S1 said that R1’s medications were not sent to any facility, but were later given to R1’s RP after R1’s RP visited to inquire as to the location of R1’s belongings. S1 said this visit occurred some time in early March 2024 but could not remember the exact date.

In an interview, S2 said that S2 delivered R1’s belongings to a certain facility where R1 did not actually move in. S2 said the staff of that facility were supposed to move R1’s belongings to R1’s current placement. S2 could not recall if R1’s medications were also sent to that facility.

LPA Moleski interviewed the house manager of R1’s current placement (S3). S3 said that medications were never brought for R1 after moving in. Instead, S3 said that R1 had come from the hospital, and had new prescriptions which were filled shortly after arrival. S3 said that R1’s clothes were dropped off approximately two weeks after R1 moved in. S3 said that staff of a separate facility, other than Abounding Love II, had dropped them off. LPA Moleski attempted to interview R1 at R1’s current placement, but R1 refused to be interviewed.

[continued on 9099-C]
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20240313114254
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 II
FACILITY NUMBER: 342700499
VISIT DATE: 06/13/2024
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
LPA Moleski reviewed R1’s file at Abounding Love II and at R1’s current placement. R1’s personal property inventory at Abounding Love II, dated 1/16/24, lists, among other things, 10 shirts in possession of R1. R1’s personal property inventory from R1’s current placement, which is undated, lists, among other things, eight shirts.

The department has determined the following as it relates to the allegations that staff mishandled a resident’s personal belongings and that staff mishandled a resident’s medications:

Based on interviews, observation, and record review, the above allegations are SUBSTANTIATED. A finding that the complaint allegations are substantiated means that the allegations are valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Sections 87217(i) and 87465(a)(4). An exit interview was held with Nonu. Appeal rights and a copy of this report were left with Moria Gaunavou.

This report was amended on 7/1/24 in order to add an additional citation per 22 CCR Section 87465(a)(4).
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20240313114254
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 II
FACILITY NUMBER: 342700499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2024
Section Cited
CCR
87217(i)
1
2
3
4
5
6
7
“Upon discharge of a resident, all cash resources, personal property and valuables of that resident which have been entrusted to the licensee shall be surrendered to the resident, or his responsible person...” This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to provide a written plan regarding transfer of resident belongings upon discharge by POC due date.
vincent.moleski@dss.ca.gov
8
9
10
11
12
13
14
Based on interviews, observation, and record review, a resident's personal property was not immediately surrendered upon discharge, which poses a potential health, safety, and/or personal rights risk.
8
9
10
11
12
13
14
Type B
06/27/2024
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
"(4) The licensee shall assist residents with self-administered medications as needed."
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to provide a written plan regarding transfer of resident medications upon discharge by POC due date.
vincent.moleski@dss.ca.gov
8
9
10
11
12
13
14
Based on interviews, observation, and record review, a resident's medications were not immediately surrendered upon discharge, which poses a potential health, safety, and/or personal rights risk.
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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
03/13/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240313114254

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: 4DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Julie NonuTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not abiding to admission agreement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski spoke with facility administrator Julie Nonu over the phone and explained the purpose of the visit. Nonu said staff member Moria Gaunavou could sign this report in her absence.

This investigation consisted of record review.

LPA Moleski reviewed R1’s file. R1 was admitted to this facility on 12/29/23, according to R1’s admission agreement. The admission agreement does not include any specific details regarding transfer of a resident's property after termination of the contract, or after the resident decides to leave the facility.

[continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20240313114254
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 II
FACILITY NUMBER: 342700499
VISIT DATE: 06/13/2024
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
The department has determined the following as it relates to the allegation that staff are not abiding to admission agreement:

Based on record review, the above allegation is UNSUBSTANTIATED, which 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.

No deficiencies were cited regarding the above allegation. An exit interview was held with Nonu and a copy of this report was left with Gaunavou.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6