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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700499
Report Date: 05/07/2024
Date Signed: 05/07/2024 12:24:28 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
05/02/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240502133806
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:
05/07/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Latoya Dowe-RoseTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff residing in garage without clearance
Insufficient staff at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to open this complaint investigation. LPA Moleski spoke with facility administrator Julie Nonu over the phone and explained the purpose of the visit.

When LPA Moleski arrived at the facility, he was allowed entrace by a resident (R1). LPA Moleski and R1 searched for staff, but found none. R1 did not know where staff members were. Three residents in the dining area were unsupervised during staff members' absence. LPA Moleski observed that a cabinet under the sink containing cleaning solutions and knives was left unlocked. A staff member (S1) appeared approximately 10 to 15 minutes later, and said S1 was busy in a resident's room caring for the resident (R6).

LPA Moleski explained that an allegation was made that there is insufficient staffing at the facility. S1 said it was "definitely true." S1 locked the cabinet and returned to R6's room, leaving the residents in the dining area unsupervised for several more minutes. No other staff members were present. [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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 4
Control Number 27-AS-20240502133806
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: 05/07/2024
NARRATIVE
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LPA Moleski reviewed this facility's file. LPA Moleski reviewed this facility's fire clearance, dated 1/22/19. The fire clearance states that "the two rooms in the garage shall only be used for storage and are not approved for habitable living space." Nonu said over the phone that S1 had been living in the garage. S1 confirmed that S1 was living in the garage and showed LPA Moleski S1's room, which is one of the rooms identified on the facility sketch as not being cleared for habitable living space.

In an interview, LPA Moleski asked S1 about night staffing. S1 said that S1 is the only staff member present at night. S1 said she sleeps in her bed in the garage throughout the night, but said that she wakes up when she hears door alarms and redirects residents inside. 22 CCR Section 87415 states that there shall be an on-call staff available during the night to supervise residents, and that staff "shall be available ... to assist in caring for residents in the event of an emergency." S1's room in the garage is separated from the main area of the facility by three doors and a laundry room, and S1 would not be able to hear a resident calling for help from their room while asleep in the garage. Additionally, as the laundry room was observed to contain cleaning solutions during this visit, the door to the laundry room must remain locked at all times. The door to the laundry room is the only interior passage to the garage in the facility. S1 confirmed that the laundry room door is locked during the night, although S1 said that residents do knock at the laundry room door at night. R6's LIC 602, dated 11/22/23, indicates that R6 is not able to independently transfer to and from bed, meaning that R6 is not able to seek out assistance from S1 during the night.

LPA Moleski reviewed six residents' LIC 603s. R1's LIC 603, dated 2/2/23, indicates that R1 needs overnight supervision. 22 CCR Section 87705 states that "a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision." R1 has dementia, according to R1's LIC 602, dated 9/21/23. S1 said that R2 wanders frequently throughout the night and needs to be checked on often. R2's LIC 602, dated 2/8/24, indicates that R2 has dementia and schizophrenia.

The department has determined the following as it relates to the allegations that staff are residing in garage without clearance and that there is insufficient staff at the facility:

[continued on 9099-C]
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20240502133806
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: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/08/2024
Section Cited
CCR
87411(a)
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"Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. ... The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services." This requirement was not met as evidenced by:
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This facility shall staff additional employees as needed per 22 CCR 87411(a). Licensee agrees to write a plan which addresses how day and night staffing needs will be met. This plan shall address the issues described in this report and previous licensing reports. Failure to adequately address staffing will result in additional civil penalties and/or additional citations.
vincent.moleski@dss.ca.gov
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Based on observation, interview, and record review, there is not sufficient staff to provide adequate supervision for residents, including overnight supervision as needed for R1, which poses an immediate health and safety risk.
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Type A
05/08/2024
Section Cited
CCR
87202(a)
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"All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal." This requirement was not met as evidenced by:
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Licensee agrees to develop a written plan to address the use of the garage room. Licensee shall send LPA Moleski this plan by POC due date.
vincent.moleski@dss.ca.gov
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Based on observation, interview, and record review, S1 has been living in a room in the garage of this facility, despite this facility's fire clearance forbidding this room for habitation, 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.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20240502133806
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: 05/07/2024
NARRATIVE
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Based on observation, interviews, and record review, the above allegations are SUBSTANTIATED, which means that the allegations are valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Sections 87411(a) and 87202(a). This facility was previously cited per 22 CCR Section 87202(a) on 12/12/23. As this is a repeat offense, an immediate civil penalty in the amount of $1,000 is hereby assessed. An exit interview was held with Nonu. Nonu said staff member Latoya Dowe-Rose could sign this report in her absence. Appeal rights and a copy of this report were left with Dowe-Rose.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4