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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700730
Report Date: 12/21/2020
Date Signed: 12/21/2020 02:24:06 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2020 and conducted by Evaluator Tuyet-Suong Teh
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20200710151002
FACILITY NAME:ABOUNDING LOVE IIIFACILITY NUMBER:
342700730
ADMINISTRATOR:NONU, JULIEFACILITY TYPE:
740
ADDRESS:5105 VILLAGE WOOD DRIVETELEPHONE:
(916) 547-0206
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 5DATE:
12/21/2020
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Julie NonuTIME COMPLETED:
02:22 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Suong Teh contacted the facility via telephone to commence a complaint investigation via telephone on 12/121/2020 due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call and the elements of the allegation(s) with the facility back up administrator Mike Her.
On 07/14/2020 the Department conducted an initial 10 days complaint investigation.
On 10/07/2020, the Department interviewed the facility administrator Julie Nonu and staff #1 (S1). Julie confirmed that there was a resident who used to stuff toilet paper in the toilet and clog it. Julie stated that the facility has two full bathrooms and if one toilet was not operable, the residents and staff can use the second bathroom. On 10/07/2020, S1 stated that she has been employed at Abounding Love III for about three months and confirmed that both bathrooms were operable. The facility administrator Julie stated that R1 had moved out and did not have R1’s current address.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
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 2
Control Number 27-AS-20200710151002
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 III
FACILITY NUMBER: 342700730
VISIT DATE: 12/21/2020
NARRATIVE
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LPA attempted to contact the reporting party on 11/06/2020 and R1’s relatives on 11/05/2020 with no success.

Based on interviews conducted and observations, the complaint allegation is facility is in disrepair is UNSUBSTANTIATED. A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

There were no deficiencies cited on today’s date.

Exit interview conducted. Copy of report sent to the facility via e-mail, the back up Administrator Mike Her to sign and return a copy to CCL either by fax or email, a copy should be retained for facility records as well.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6803
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2