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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005215
Report Date: 01/06/2022
Date Signed: 01/06/2022 03:55:07 PM

Document Has Been Signed on 01/06/2022 03:55 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:
01/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Caregiver, Nellie Morate,TIME COMPLETED:
04:00 PM
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 Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Caregiver, Nellie Morate, who contacted Virginia Bonite, Administrator, and explained purpose of 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: KN95 Mask. There are (5) residents at the facility and no residents are currently receiving hospice services.

LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, (2) shared resident bedrooms, (1) private bedroom, (1) restrooms, kitchen, dining room, laundry area and staff room . In the areas toured no immediate health, safety, or personal rights violations were observed. LPA observed sufficient food and PPE supply. LPA and caregivers completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 74* F. Fire extinguisher was last serviced 12/6/2021. LPA's observed required postings in the facility. LPA's and Administrator discussed vaccination status of residents and staff and LPA observed documentation of either vaccination status or exemption on file, as well as testing documentation. Discussed visitation protocols per PIN 21-40 issued 8/27/2021. LPA's observed current Administrator certificates posted.

Updated LIC500 and LIC308 were provided in August 2021. There were no deficiencies observed during today's inspection.

Exit interview. Copy of report provided to Administrator.




SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2022
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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