342700730-2-20-2025-27-AS-VMOI-DE3V55-20250220150722

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700730
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:07:27 PM

Document Has Been Signed on 02/20/2025 03:07 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 III		FACILITY NUMBER:	342700730
ADMINISTRATOR/ DIRECTOR:	NONU, JULIE		FACILITY TYPE:	740
ADDRESS:	5105 VILLAGE WOOD DRIVE		TELEPHONE:	(916) 547-0206
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY: 6		CENSUS: 5	DATE:	02/20/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Julie Nonu		TIME VISIT/ INSPECTION COMPLETED:	03:15 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) Vincent Moleski arrived unannounced on February 20, 2025 to follow up on a substantiated complaint investigation. LPA Moleski sent a text message to facility administrator Julie Nonu explaining the purpose of the visit. Nonu was not available at the time of this visit, but said staff member Ratumanoa Namusudroka could sign this report in her absence. On September 19, 2023, the Department concluded a complaint investigation which alleged that staff did not ensure that a resident (R1) was adequately fed while in care, and that, due to staff neglect, a resident sustained pressure injuries while in care. Both allegations were substantiated, and the licensee was cited for California Code of Regulations, Title 22, Section 87464(f)(3) Basic Services and California Code of Regulations, Title 22, Section 87211(a)(1)(B) Reporting Requirements. Resident 1 (R1) was admitted to this facility on September 27, 2022, with no pressure injuries documented on R1’s LIC 602. The LIC 602 also indicated that R1 did not have a history of skin breakdown, and R1’s preadmission appraisal did not indicate any other injuries or wounds. An incident report sent by this facility to the Department on June 12, 2023, indicated that R1 was sent to the hospital on June 8, 2023, due to pain from an open wound. According to R1’s medical records, R1 was diagnosed with multiple pressure injuries, including a stage 3 to 4 wound on the sacrum, stage 3 wounds on the ankles and thighs, and a stage 1 injury on the left heel. R1’s medical records indicated a “concern for inadequate level of care” and “neglect.” The medical records show that R1 was discharged on June 9, 2023, with wound care instructions and supplies, and a referral for home health services, which were never acquired. [continued on 809-C]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 III	FACILITY NUMBER: 342700730
	VISIT DATE: 02/20/2025

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R1 was sent back to the hospital on June 24, 2023, with a stage 3 pressure injury in an unspecified location, a stage 4 pressure injury on the sacrum, a stage 4 wound on the left thigh, an unstageable wound on the right thigh, and a stage 1 wound on the left foot, according to medical records.

Interviews were conducted with Nonu and two staff members (S1-S2). S2 said they were “constantly” notifying Nonu of the wounds in order to secure wound care for R1. S2 said that R1 needed a higher level of care and said R1 was not taken to the hospital sooner because Nonu did not take the wounds seriously. Nonu said that R1 needed a higher level of care and said that R1 should have been sent to the hospital sooner.

At the time of the complaint visit on September 19, 2023, no immediate civil penalties were assessed, but the licensee was informed that civil penalties may be assessed at a later date, pursuant to Health and Safety Code Section 1569.49.

The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility not providing the care and supervision necessary to meet R1’s wound care and nutritional health care needs resulting in worsening pressure injuries and weight loss due to protein calorie malnutrition.

Today, February 20, 2025, the Department is assessing a civil penalty per Health and Safety Code Section 1569.49 for a violation that the Department constitutes as a serious bodily injury in the amount of $10,000.

An exit interview was held with Namusudroka. Appeal rights and a copy of this report were left with Namusudroka. Namusudroka's signature on this report acknowledges receipt of the appeal rights, which are found on page two of the LIC 421D form.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025

LIC809 (FAS) - (06/04)

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