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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701013
Report Date: 11/26/2024
Date Signed: 11/26/2024 03:03:19 PM

Document Has Been Signed on 11/26/2024 03:03 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:ABUNDANT PEACEFACILITY NUMBER:
342701013
ADMINISTRATOR/
DIRECTOR:		BARNES, STACIFACILITY TYPE:
740
ADDRESS:19 SYNTHIA COURTTELEPHONE:
(916) 856-6464
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 6CENSUS: 0DATE:
11/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Marvin TibbetsTIME VISIT/
INSPECTION COMPLETED:
03:15 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 11/26/2024, Licensing Program Analysts (LPAs) Pang Lee and Holly Williams arrived unannounced to this facility to conduct an annual visit. LPAs met with care staff Marvin Tibbits. LPAs asked care staff to call Licensee Murphy Gant to informed that CCLD is present in the home. A brief interview was conducted via telephone with licensee Murphy who stated that he is not able to join the visit and that care staff Marvin can assist and sign the report. The administrator to this facility is Staci Barnes who has an expired administrator certificate. LPAs informed licensee that the facility needs a current and active administrator. It was learned that there are currently no residents residing at the facility at this time.

LPAs toured the facility and observed multiple health and safety concerns. These concerns must be addressed, and licensing must be contacted for an additional inspection prior to the admittance of any residents. If licensing is not informed, and the inspection is not completed prior to admitting any residents into care, Administrative Actions may be taken.

The following were addressed to the licensee Gant:
• No residents will be accepted unless the Department has been notified prior to admission.
• A mandatory reinspection must take place prior to accepting any residents
• Licensee will remain available to the Department for contact by phone or email.
• Facility must have a current administrator.

The following was observed and addressed with the licensee to be corrected:
• All toxins shall be locked and inaccessible to residents in care.
• All sharp objects shall be locked and inaccessible to residents in care.
• All resident accommodation should include the required furniture: chest of drawers, bed, night stand, lamp/lighting sufficient for reading, and a chair.
[809 continued on 809-C]
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ABUNDANT PEACE
FACILITY NUMBER: 342701013
VISIT DATE: 11/26/2024
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
26
27
28
29
30
31
32
•The facility shall be in good repair and all debris and other discarded items shall be removed from the facility's property.
• The Licensee shall remove the dried vegetation, and weeds.
• The following shall be posted and visible to residents in care: The Administrator's Certificate, facility sketch, the Local Ombudsman poster, CCLD complaint poster.
• The Licensee shall repair/replace any missing window screens or screens that are not fitted.
• 2 days perishable and 7 days nonperishable shall be at the facility at all times.
• Ramps needs to be installed for the patio deck, front door, and back door.
• Licensee will ensure a telephone service is always on the premises.
• The licensee will ensure that personal records are maintained on all facility staff and available upon request.
• The licenses will ensure that there are activities made accessible to residents in care.
• Ensure all sheds are locked at all times.
• Garage will be decluttered and ensure all potential hazard are locked.

No deficiencies being cited during today's annual visit, an exit interview was conducted, and a copy of this report was provided to the facility at the end of this visit.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2