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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700827
Report Date: 11/21/2024
Date Signed: 11/21/2024 12:32:34 PM

Document Has Been Signed on 11/21/2024 12:32 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 PEACE ELDERLY CAREFACILITY NUMBER:
342700827
ADMINISTRATOR/
DIRECTOR:		WAQALALA, UNAISIFACILITY TYPE:
740
ADDRESS:7124 HAYWARD DRTELEPHONE:
(916) 578-8834
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:18 PM
MET WITH:Andora MontaqueTIME VISIT/
INSPECTION COMPLETED:
12:41 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
On 11/20/2024, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a case management visit. LPA were met by caregiver Andora Montaque and explained the purpose of this visit. The census is 8. Care staff Andora attempted to reached administrator Unaisi Waqalala via telephone.; however, administrator didn't answer the call. During today's visit administrator was not present.

The purposed of today's visit is deliver the Order to Licensee/Facility of Immediate Exclusion and explained that staff (S1) is excluded from any involvement in the facility effective immediately.

No citations were issued on today's date. A copy of this report and exclusion letter was provided to the facility care staff Andora Montaque at the end of this visit.
Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
Pang LeeTELEPHONE: (916) 508-9726
DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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