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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005215
Report Date: 10/27/2023
Date Signed: 10/27/2023 12:39:54 PM


Document Has Been Signed on 10/27/2023 12:39 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: 5DATE:
10/27/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Virginia BoniteTIME COMPLETED:
12:35 PM
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On 10/27/2023, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required quarterly case management visit in accordance with the Stipulation and Waiver; And Order, effective date 02/07/2022 to 02/07/2025. LPA met with Administrator, Virginia Bonite, and explained the purpose of the visit.

LPA and Administrator conducted a tour of the facility to ensure the health and safety of residents in care. LPA observed five residents to be present in their rooms.

LPA and Administrator discuss facility's previously submitted request for probational term reduction. LPA informed Licensee the request is still under review by the Department. Administrator was informed LPA will update Licensing Program Manager Anthony Perez of today's visit.

LPA observed the stipulation to be posted in a conspicuous space. LPA conducted a file review of facility's Stipulation binder. LPA observed monthly training documentation for August 2023, September 2023 and October 2023. LPA observed staff certificate of completion for the following training topics:

- August 2023: Wandering Within and Outside of the Facility
- September 2023: Memory Behavior
- October 2023: Special Needs of Persons With Alzheimer's Disease and Dementia.

At this time, LPA found facility to be in compliance with the Stipulations and Waiver; And Order. No deficiencies observed.

Exit interview conducted and a copy of report was provided to Administrator.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023
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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