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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700499
Report Date: 03/29/2024
Date Signed: 03/29/2024 12:04:54 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
01/31/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240131121128
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:
03/29/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Latoya Dowe-RoseTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff did not provide a safe environment for resident in care resulting
in resident hitting another resident in care.
INVESTIGATION FINDINGS:
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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 Latoya Dowe-Rose could sign this report in her absence.

This investigation consisted of interviews, observation, and record review. LPA Moleski interviewed Nonu, a staff member (S1), two residents (R2-R3), and a resident’s responsible party (R1 RP).

During an interview, S1 said that there was an altercation between R1 and R2 on the morning of January 3. R2 had been telling R1 how to eat breakfast, according to S1, R1 brushed R2’s hand away, which sparked a physical altercation, according to S1. S1 said S1 was not present during the altercation, but was busy changing linens in a bedroom.
[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: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024
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-20240131121128
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: 03/29/2024
NARRATIVE
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By the time S1 went out into the dining area, R1 was punching R2 in the face. S1 took photographs of each residents’ injuries and provided them to LPA Moleski. R2 was bleeding near the eye, and R1 appeared bruised and was red in the eye.

R3 witnessed the altercation that took place on January 3. R3 said that R2 was “harassing” R1, and reached a hand near R1, which annoyed R1. R3 said the two started fighting, and described both throwing punches. R3 said no staff members were present during the fight.

S1 said that police were called after the incident. Officers asked S1 to keep the residents separated.

S1 said that a second altercation took place on January 16. On this date, S1 returned from feeding another resident in their room to find R1 with redness in the eye. S1 said that R2 told S1 that R2 had hit R1 because R1 was making noises.

R3 witnessed the incident on January 16 as well, and said that R2 had finished breakfast, then returned to the dining area to either kick R1’s wheelchair and/or punch R1, and told R1 to “shut the hell up,” or something to that effect, because R1 was making noises.

LPA Moleski did not receive incident reports regarding either of these altercations. This deficiency will be addressed on a separate case management visit.

LPA Moleski reviewed R1’s and R2’s files. R2’s LIC 602 indicated that R2 is able to follow instructions and is able to communicate needs. R1’s LIC 602 indicated that R1 is “easily reoriented” and able to follow instructions.

The department has determined the following as it relates to the allegation that staff did not provide a safe environment for a resident in care resulting in a resident hitting another resident in care:

Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. This facility is hereby cited per 22 CCR Section 87468.1(a)(2). An exit interview was held with Nonu. Appeal rights and a copy of this report were left with Dowe-Rose.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024
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
01/31/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240131121128

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:
03/29/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Latoya Dowe-RoseTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff did not ensure resident's medications are being filled.
Staff did not ensure resident's physician's report was complete upon admissions.
INVESTIGATION FINDINGS:
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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 Latoya Dowe-Rose could sign this report in her absence.

This investigation consisted of interviews, observation, and record review. LPA Moleski interviewed Nonu, a staff member (S1), two residents (R2-R3), and a resident’s responsible party (R1’s RP).

LPA Moleski reviewed R1’s medications on 2/6/24. R1’s medications were not complete, and several medications had evidently ran out prior to the visit. LPA Moleski reviewed R1’s medication administration records and observed that several medications had run out by mid-January. R1 was admitted to the facility near the end of December 2023 and left the facility around the end of January.
[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: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024
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-20240131121128
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: 03/29/2024
NARRATIVE
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During interviews, Nonu, S1, and R1’s RP all said that R1’s medications were not filled due to insurance issues preventing prescriptions from being written. During an interview, Nonu said that R1 did not have a primary doctor upon arrival, which prevented refills from being filled. Nonu said attempts were made to fill medications through urgent care. During an interview, S1 said that a meeting was held with R1’s social worker in an attempt to make arrangements for refills. During an interview, R1’s RP said that R1 arrived at the facility with no refills prescribed, and R1 could not get new refills because R1 did not have a primary doctor. R1’s RP said that R1 could not get a primary doctor because R1’s RP needed proof of insurance and proof of income documentation, which could not be immediately obtained by R1’s RP.

LPA Moleski reviewed R1’s LIC 602. The LIC 602 appeared to be complete. R1’s RP said during an interview that the doctor who filled out the form provided inaccurate information.

The department has determined the following as it relates to the allegations that staff did not ensure resident’s medications are being filled, and that staff did not ensure resident’s physician’s report was complete upon admissions:

Based on interviews and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

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

DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240131121128
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: 03/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/30/2024
Section Cited
CCR
87468.1(a)(2)
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“(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights…
(2) To be accorded safe, healthful and comfortable accommodations…”
This requirement was not met as evidenced by:
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Licensee agrees to provide a written plan to prevent further altercations between residents in the future.
vincent.moleski@dss.ca.gov
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Based on interviews and record review, R1 and R2 were not provided safe or healthful accommodations, 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: 03/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5