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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005215
Report Date: 06/06/2022
Date Signed: 06/06/2022 04:45:10 PM


Document Has Been Signed on 06/06/2022 04:45 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



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: 5DATE:
06/06/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Virginia Bonite, Administrator TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required case management inspection. LPA met with Virginia Bonite, Administrator, and explained purpose of inspection. LPA observed caregiver, Maria Maciuca, also present during today's inspection.

Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, contacted the facility to confirm there are currently no positive Covid-19 diagnoses, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask. There are (5) residents at the facility and no residents are currently receiving hospice services.

LPA and Administrator reviewed the training binder containing documentation of the initial (6) hours completed by the Administrator pursuant to the order dated 2/7/2022. Training was completed with (2) different outside companies on 3/19/2022 and on 3/30/2022, within 60 days of the order dated 2/7/2022.

LPA observed monthly training documentation for April 2022, conducted by the Administrator on 4/7/2022 for (3) of (3) staff members (S1, S2 and S3). The training materials were taken from an approved vendor source. LPA observed monthly training documentation for May 2022, conducted by the Administrator on 5/3/2022 for the same (3) staff members. June training is scheduled to be completed by 6/15/2022.

LPA observed documentation that (2) payments have been submitted to the Department. A probationary license was printed during today's inspection and posted by the Administrator. LPA received documentation that was mailed on 3/4/2022 with a summary of night time care and supervision for residents with dementia per the order.

There are no deficiencies issued today. LPA advised there will be a subsequent quarterly case management inspection on/around September, 2022.

Exit interview. Copy of report printed for Administrator.


SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
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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