<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700730
Report Date: 12/03/2024
Date Signed: 12/03/2024 12:08:49 PM

Document Has Been Signed on 12/03/2024 12:08 PM - 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 IIIFACILITY NUMBER:
342700730
ADMINISTRATOR/
DIRECTOR:
NONU, JULIEFACILITY TYPE:
740
ADDRESS:5105 VILLAGE WOOD DRIVETELEPHONE:
(916) 547-0206
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/03/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:41 AM
MET WITH: Ratumanoa NamusudrokaTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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) Pang Lee arrived unannounced to conduct a health and safety case management visit. The facility is on a quarterly visit due to non-compliance concerns discussed during an office meeting on 04/23/2024. LPA met with care giver Ratumanoa Namusudroka who then notified administrator Julie Nonu that CCLD were present in the home. Administrator was not able to join the visit. LPA explained the purpose of the visit. The census is 6 with 1 facility staff.

LPA and care staff Ratu Manoa toured the physical plant to ensure compliance with Title 22 regulations. LPA observed 6 bedrooms, 2 resident bathrooms, common area, staff room, smoking area, kitchen, laundry room, garage, and the courtyard. LPA observed resident bedrooms to have necessary furniture and furnishings. Bedrooms were equipped with a bed, chair, dresser, and closet space. Bathrooms handrails and non-skid mats are in good repair. Hot water temperature was measured at 114.6 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers were up to date and fully charge. No emergency exits were obstructed. LPA reviewed food supply to ensure that the facility had a 2-day perishable and 7-day nonperishable food supply and it were sufficient. LPA observed the garage and observed the laundry room where it was observed that detergent, and all cleaning supplies were locked and made inaccessible to residents at this time. Knives were observed to be locked and made inaccessible. First aid kit was checked, and it is complete. LPA requested to review 5 resident files and 2 staff files. Staff files and resident files were observed to be complete. LPA Lee reviewed 4 resident medications and it was not accurate and complete.

As a result of this visit, the facility is not in compliance with Title 22 Regulation, and the deficiency will not be cited since citations is already being issued on 12/03/2024 annual inspection. An exit interview was conducted, and a copy of these LIC 809 report was provided to the facility.

Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
Pang LeeTELEPHONE: (916) 508-9726
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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