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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005215
Report Date: 08/01/2024
Date Signed: 08/01/2024 01:26:10 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2024 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20240725162303
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: DATE:
08/01/2024
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Nellie Morate and Virginia BoniteTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff does not allow resident to go outside.
Staff refused to provide resident's records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cassie Yang arrived uannounced at the facility to open a complaint the Department received regarding the allegations cited above. LPA met with Caregiver and explained the purpose of the visit. Caregiver then contacted Administartor via telephone, who arrived to the facility shortly afterwards.

During today's investigation, LPA conducted extensive interviews and file review.

The results of the allegation are as follow on LIC 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 59-AS-20240725162303
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
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 ELDERLY
FACILITY NUMBER: 347005215
VISIT DATE: 08/01/2024
NARRATIVE
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**LIC 9099-C**

Allegation: Staff does not allow resident to go outside.
The Department conducted interviews. Based on interview with R1, it revealed staff does assist R1 to go outside if needed. R1 stated R1 has frequent bladder impairment so they do not go outside much but R1 likes to sit at the porch occasionally. Interview with Administrator, it revealed right now it is too hot to go outside but if requested facility complies. It further revealed that if R1 has doctors appointment, facility does assist with transportation. Administrator stated all residents in care are free to leave the facility to stay outside if desired.

Based on information obtained through interviews, the allegation listed above is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegation: Staff refused to provide resident's records
The Department conducted interviews. Based on interview with R1, it revealed R1 is unsure of this allegation. Interview conducted with Administrator revealed that another assisted living facility had inquired for R1's facility documents through a caregiver who did not understand the request. Administrator explained that fax number was then provided to R1 to provide to the assisted living facility for the request to be faxed to the facility. Administrator stated the request included R1's LIC602A which Administrator then inquired a new one from R1's primary care physician. Administrator explained that records were not refused but it is still in progress. Records reviewed revealed Administartor had submitted a request for updated LIC602A on July 26, 2024

Based on information obtained through interviews and file review, the allegation listed above is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of report provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2