<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
342700730
Report Date:
12/28/2023
Date Signed:
12/28/2023 11:28:34 AM
Document Has Been Signed on
12/28/2023 11:28 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
ABOUNDING LOVE III
FACILITY NUMBER:
342700730
ADMINISTRATOR:
NONU, JULIE
FACILITY TYPE:
740
ADDRESS:
5105 VILLAGE WOOD DRIVE
TELEPHONE:
(916) 547-0206
CITY:
SACRAMENTO
STATE:
CA
ZIP CODE:
95823
CAPACITY:
6
CENSUS:
4
DATE:
12/28/2023
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
11:00 AM
MET WITH:
Ehon Mellis
TIME COMPLETED:
11:30 AM
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
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a collateral visit. LPA Moleski spoke with facility administrator Julie Nonu over the phone and explained the purpose of the visit. Nonu said staff member Ehon Mellis could sign this report in her absence.
LPA Moleski interviewed a resident (R1).
No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Mellis.
SUPERVISOR'S NAME:
Stephen Richardson
TELEPHONE:
(916) 263-4746
LICENSING EVALUATOR NAME:
Vincent Moleski
TELEPHONE:
(559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE:
12/28/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1