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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700499
Report Date: 02/11/2022
Date Signed: 02/11/2022 02:46:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
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: 6DATE:
02/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:Aliti Natoga WaqalalaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct an annual inspection. LPA confirmed with facility staff that there are no active cases. LPA Valerio was screened for COVID-19 symptoms with temperature taken prior to being allowed entry into the facility.

LPA Valerio discussed recent PIN 22-07, and reviewed facility COVID tracking procedures and documentation. The facility common areas were free from debris. Emergency exits were not blocked. COVID-19 signs regarding social distancing, hand washing, infection control, and prevention strategies are placed at the front of the facility. The common areas were clean and organized. During the visit, the facility was observed to be following all policies related to vaccinations, visitors, and the health and safety of the residents.

LPA Valerio and staff toured the physical plant inside and out to ensure compliance with Title 22 regulations. All emergency exits were clear from obstructions. LPA observed an emergency supply of food, water, and supplies. Medication cabinet, cleaning supplies, sharps were locked away and inaccessible to residents in care. Hot water was measured at 105.6*F. Room temperature was set to 73*F. All required furniture and furnishings were observed in the resident bedrooms and bathrooms. All bathrooms were stocked with soap, paper towels, and hand sanitizer. Resident rooms were clean and organized. Fire extinguishers were observed to be charged and within compliance with last check on 06/04/2021.

LPA reviewed one staff file, reviewed one resident file, and interacted with multiple residents during the visit.

LPA requested copies of the following to be sent to LPA Hubbard via fax: LIC 500, LIC 308, LIC 309, Updated Adminitrator Certificate, LIC 601E, and liability insurance

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left at the facility with Aliti Natoga Waqalala.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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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