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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005215
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:10:34 PM


Document Has Been Signed on 01/24/2024 12:10 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ABUNDANT LOVE AND CARE FOR THE ELDERLYFACILITY NUMBER:
347005215
ADMINISTRATOR:BONITE, VIRGINIAFACILITY TYPE:
740
ADDRESS:2607 WALNUT AVENUETELEPHONE:
(916) 481-6817
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 4DATE:
01/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Nellie Morate and Virginia BoniteTIME COMPLETED:
12:20 PM
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On 1/24/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the full care tool. LPA met with caregiver who contacted Administrator who arrived to the facility shortly afterwards.

During today's inspection, LPA observed the license posted to be inaccurate to the license on FAS. LPA printed, signed and provided facility with the update license.

Facility is licensed six non ambulatory residents, hospice waiver of three. Today's census is four with no residents on hospice services.

LPA and Administrator conducted a tour of the facility. Areas toured included but not limited to: kitchen, residents room, staff room, bathroom, and the common areas. LPA observed facility to have the required posters posted in the common area. LPA observed medications, sharps, toxins to be locked and secured. LPA and Administrator discussed ensuring to lock laundry room at all times. LPA observed facility to be at a comfortable temperature of 71*. LPA observed facility to have 2+ days of perishable and 7+ days of nonperishable foods. Administrator Certificate posted for #6016228740 is active with expiration date of 06/07/2024. LPA obtained a copy of facility liability insurance, effective date of 3/26/2023 to 3/26/2024.

LPA conducted a file review of R1, R2, R3 and R4. LPA and Administrator completed the inspection tool and found the facility to be in compliance. No deficiencies cited.

Exit interview conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024
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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