Abounding Peace III Elderly Care

Allegation investigated: The facility allowed excluded individuals to work in the facility. Staff are forging resident documents.

On July 22, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct a follow-up investigation visit. LPA initially met with staff on duty, Patrice Patterson (S1) and stated the purpose of the visit. The assistant administrator, Esther Tabua (S2) was notified and arrived later during the visit. Present upon arrival were six residents with one staff on duty. Allegation - The facility allowed excluded individuals to work in the facility: The investigation into this allegation consisted of interviews, record reviews and observations. On February 19, 2026, interviews were completed with 5 of the 5 residents. Of the five residents who were interviewed, two could not say if they had seen the excluded individuals, E1 or E2, at the facility after being shown their photos. One of the resident stated they had seen E2 but could not remember the exact or approximate date. Staff interviews revealed that when shown photos of E1 and E2, staff stated they knew both individuals. At least two staff members stated they had not seen either of them at the facility since starting employment. {1 of 2} Unsubstantiated At least one staff member stated that they had not seen E1 at the facility since employment but stated they saw E2 at the property about one month earlier or at least one time since starting work. This staff stated when E2 was here E2 remained outside with a maintenance person and did not enter the facility and that only the maintenance person went inside; they could not confirm whether E2 had any contact with residents. Additional interviews was conducted on July 22, 2026 where one resident who stated who also confirmed, after being shown photos of E1 and E2, R6 stated they did not recognize either individual and had not seen them at this facility since admission. A review of the facility's LIC 500 Personnel Report found that E1 and E2 were not listed as employees. During facility visits on February 19, 2026, June 10, 2026, and July 22, 2026, no excluded individuals were observed at the facility and there were no reports that E1 or E2 were working there. Based on interviews, record review, and observations, there was not enough evidence to show that the facility allowed excluded individuals to work in the facility. Therefore, the allegation is unsubstantiated. **************************************************************************** Allegation - Staff are forging resident documents: The investigation into this allegation consisted of interviews and record reviews. On July 22, 2026, LPA Villanueva contacted the medical offices listed on the residents' Medical Assessments (LIC 602A) to verify whether the residents had been seen by their physicians. Some residents receive medical care through Kaiser and Dignity Health. The representatives stated they could not release or verify patient information because of their privacy policies. At least one resident receives care through a clinic which confirmed the resident's medical assessment information to be accurate. Two other residents receive care through another clinic and they were able to verify these residents in their care. Interviews with staff members on February 19, 2026 and July 22, 2026, they stated they were not aware of any staff or the administrator forging resident documents or asking them to alter or change resident records. Based on the information gathered during the investigation, there was not enough evidence to show that staff were forging resident documents. Therefore, the allegation is unsubstantiated. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview was conducted with Esther Tabua and a copy of this report and appeal rights were provided. {2 of 2} A review of Licensing Program Analyst (LPA) visits on February 19, 2026, June 10, 2026, and July 22, 2026, showed that the administrator was not present during any of the three visits. A review of the facility's Personnel Report (LIC 500), dated June 15, 2026, showed the administrator was scheduled to work at the facility on Mondays and Thursdays from 9:00 a.m. to 7:00 p.m. During interviews, staff gave different statements about how often the administrator is at the facility. One staff member stated the administrator comes to the facility about one time per week and stays about five to six hours each visit. Another staff member stated the administrator comes about two times per week but could not remember the last time they saw the administrator at the facility but stated the administrator usually stays four to five hours each visit. Another staff stated the administrator comes to the facility two to three times per week and stays about eight hours each visit. These statements were not consistent with each other and did not match the administrator's work schedule listed on the LIC 500. Resident were also interviewed about the administrator's presence at the facility. At least 4 of 6 residents stated they do not know who the administrator, Una, was when asked and are unable to confirm if administrator Una is present at this facility at a sufficient amount of time. Based on the administrator not being present during multiple LPA visits, the conflicting staff statements about how often the administrator is at the facility, and residents being unable to identify or recall seeing the administrator, the evidence supports that the administrator was not present at the facility for a sufficient amount of time. Therefore, the allegation is substantiated. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. Plan of correction and appeals were discussed during the exit interview with Esther Tabua; and a copy of this report and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Jul 22, 2026 · control 27-AS-20260211103325

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Jul 30, 2026

The administrator…shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. This requirement is not met as evidenced by: Based on interviews, record reviews and observations, the administrator were not present during multiple LPA visits, the conflicting staff statements about how often the administrator is at the facility, and residents being unable to identify or recall seeing the administrator. This poses a potential health, safety, or personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2026

Plan of correction: Per discussion, the administrator will start documenting their presence at the facility including the date, arrival time, departure time, and duties completed during each visit; will title it Administrator Visit Log. Administrator Visit Log from 7/22/26 to 7/29/26 will be submitted to the Department by POC due date.

Type of visit: Required - 1 Year

On June 10, 2026, Licensing Program Analysts Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPAs met with the assistant administrator, Esther Tabua (S1) and stated the purpose of the visit. The administrator, Unaisi Wagalala (AD) was notified and stated she is not feeling well today and designated S1 to assist with the annual and sign this report. Overview: Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, up to 6 may be non-ambulatory. Facility has a clearance for 1 bedridden room (Room #5 on the facility sketch). Facility does not have clearance for delayed egress, and locked exterior/interior. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident units, resident bathrooms, dining room and outdoor areas. LPA and S1 inspected 5 of 5 resident bedrooms and 3 of 3 bathrooms. Hot water temperature was measured at 108 to 110 degrees Fahrenheit. During inspection of the bathrooms, LPA observed one of the bathroom (next to Room #1), the shower tub does not have a grab bar installed, and cleaning solutions and sprays were observed under the sink (photo taken) – accessible to residents. The bathroom at the other hallway, next to Room #3, one of the grab bars was loose and the doorknob was observed to be taped which prevents residents from locking the bathroom for privacy (photo taken); also in this bathroom, LPA found a cleaning spray (photo taken) in the medicine cabinet, accessible to residents in care. Inside Room #4, LPA observed a cleaning spray (photo taken) and next to it was Pepto Bismol (photo taken); the bedside table, LPA observed a bottle of Multivitamin (photo taken). This room belongs to resident (R5). Per review of R5’s Medical Assessment (LIC602A) dated 8/23/25, R5 is not able to administer own medications. This room can be accessed by other residents who per their LIC602As, they were assessed to be at risk if they have direct access to cleaning solutions, vitamins, and other similar and dangerous items. Per observation, S1 immediately put away these items as instructed by LPA Villanueva. {1 of 2} Hallway temperature was maintained at 72 degrees Fahrenheit during this visit. Fire door was observed to be closed. Advisory was provided to rearrange their couch in the family room because it was observed to be partially blocking the exit door to the backyard (photo taken). In the kitchen area, LPAs observed at least 7-day nonperishable and 2-day perishable food supplies. Refrigerator and freezer were within regulatory temperature. Knives/sharps were locked in a drawer. Fire extinguishers observed and last serviced on 3/31/2026. Smoke detectors were observed throughout and at least one carbon monoxide detector was observed. Medication cabinet was observed to be locked and not accessible to residents. Outdoor area was inspected. One of the walkways was observed to be obstructed by plants (photo taken). Fences were observed to be in good repair at this time. One of the exit gates needs to be repaired as the bottom was dragging as LPA tried to open it. No bodies of water were observed at this time. There is a shaded area for outdoor activities. LPA observed outdoor furniture. S1 was unsure of the location of all shut-off valves; S1 was able to locate the electric panel. S1 was unsure how to operate the gas and water. Advisory was provided to ensure all staff know the location of each of the shut-off valves and know how to operate each one in case of emergency. Record Reviews: Review of 5 of 5 resident files was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. During this review, LPA did not observe PRN Authorization Letter for each of the residents. Also, LPA noted that the residents with restricted health conditions do not have restricted health care plan in place. Additional review is needed. Medication review was conducted for 1 resident at this time, including review of resident’s medication, PRN authorization letter, prescription records, Centrally Stored Medication Records, and Medication Administration Records. Additional review is needed. Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. Per review of Guardian and LIS, staff on duty during this visit (S2) was not associated at this facility. Per review of facility’s Personnel Report (LIC500) dated 5/18/2026, S2 has been working at this facility since May 15, 2026. During this visit, the AD associated S2 to this facility. LPA rechecked Guardian to confirm. Based on today's visit, this annual will require a continuation. A follow up visit will be conducted at a later date. Deficiencies observed during today's visit will be cited on the next visit. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 10, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Sommer Hayes conducted a case management visit to the facility on 08/28/25 at 2:15pm for the purpose of delivering an Order To Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion From Facility. LPA Hayes met with Designated Facility Administrator (DFA) Luisa Amele Saqusaqu and explained the purpose of today's visit. Staff (S-1) excluded as a result not related to this facility. LPA Hayes handed the Order to Licensee/Facility of Immediate Exclusion From Facility letter to DFA Luisa Amele Saqusaqu and explained that staff is to leave the facility immediately. DFA stated that S1 does not work at this facility currently and has not for 4 years.the state’s words, verbatim · CDSS document, Aug 28, 2025

Type of visit: Required - 1 Year

On 6/16/2025, Licensing Program Analyst Arvin Villanueva (LPA) arrived at this facility unannounced to conduct their required annual inspection. LPA met with staff on duty, Luisa Saqusaqu (S5) and stated the purpose of this visit. The Administrator, Unaisi Waqalala, was notified and informed she was unable to be present during this inspection. Present during today's visit were 4 residents in care with 1 staff on duty (S1). Upon arrival LPA observed one resident at a dining table near the entrance of the facility. Another resident in the living room watching TV then eventually went to their bedroom. Per S1, residents just finished their lunch. One resident was observed in their bedroom listening to music with their headphones. Another resident was observed to be sitting in their bedroom, who then went to the bathroom during the physical inspection. LPA evaluated the physical plant with S5 to ensure the health and safety of the residents in care. The facility is a one-story home located in a residential neighborhood. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 5 of 5 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the hot water temperature in 1 of 2 resident bathroom to be 113 degrees Fahrenheit. Room temperature was observed at 82 degrees Fahrenheit upon arrival. LPA observed sufficient seven day non-perishable and two day perishable food supplies. One fire extinguisher was observed and were last inspected on 4/3/2025. Smoke and carbon monoxide detectors were observed and tested and found to be operable at this time. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. No bodies of water was observed at this time. Fireplace was observed to be screened and non-operational at this time. Exit doors have audible alarms. A medication box was observed inside the kitchen refrigerator and was found to be locked and not accessible to residents in care. Con't 809-C Outdoor area was inspected. Facility has a covered porch equipped with outdoor furniture for resident use. Facility has 2 side gate exits. The right side of the facility (garage side), LPA observed the gate to be in disrepair as evidenced door stopper sticking out with nails exposed. The side fence has part of it with nails sticking out. Photos were sent to Administrator. Review of 5 resident files (R1, R2, R3 R4, R5) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. One resident (R5) did not have their Admission Agreement on file available for review during this visit. Review of 5 staff files (S1, S2, S3, S4, S5) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. It was noted that one staff (S4) was not associated to this facility. Record review of S4's training indicated that staff started on 11/15/2024. Additionally, it was discovered that S4's health screening was completed on 9/7/2023. Furthermore, review of S2's files revealed that S2 was associated to this facility on 5/30/25 and through interview with S3, S2 worked early in June 2025 to relieve S3. However, LPA discovered that S2's last health screen/TB test was completed on 6/19/2023. Administrator to submit current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Based on today's visit, this annual will need continuation. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, following deficiencies were observed during today's visit: R5 did not have their Admission Agreement on file available for review. S2 did not have current Health Screening/TB test completed prior to working at this facility. S4 is not associated to this facility but per review of their training record indicated that their start date was on 11/15/24. Fence and side gate needs repair as evidence of nails sticking out. Citations will be issued when this annual is completed. The Department will return at a later date to complete the annual inspection. Exit interview was conducted and a copy of the report was provided upon exit.the state’s words, verbatim · CDSS document, Jun 16, 2025

Allegation investigated: Staff handled resident in a rough manner while in care.

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to deliver complaint investigation findings. LPA Valerio met with facility staff Ilaisa Niutabua, and explained the purpose of the visit. The investigation consisted of interviews with staff, interviews with residents, and facility record review. The following has been determined as it relates to the aforementioned allegations. According to a report provided to the Regional Office, it was alleged that Resident 1 (R1) was pushed two (2) times by a staff member and had their cathetar ripped from their body. LPA attempted to contact the reporting party three times; however, was unsucessful. LPA Valerio interviewed staff. Staff 1 (S1) reported S1 has not seen any staff hit, push, or yell at residents.S1 reported having a good relationship with all the residents. Continues on LIC 9099 - C... Unsubstantiated Continues from LIC 9099 S1 stated R1's catheter was leaking and had to be sent to the hospital. S1 stated staff do not touch the catheter and only nursing staff does it. According to an interview with Staff 2 (S2), S2 remember R1. R1 was observed by S2 cutting R1's own catheter bag. S2 reported R1 would find random items to cut the bag. R1 would do this multiple times and be sent to the hospital each time. S2 reported the last time R1 was sent to the hospital, R1 never came back. According to an interview with Staff 3 (S3), S3 does not remember R1. LPA Valerio interviewed residents. LPA Valerio was unable to find information for R1 to conduct an interview. LPA Valerio interviewed Resident 2 (R2). R2 reported staff being great and had nothing to complain about here. R2 has not observed staff handling residents in a rough manner. According to an interview with Resident 3 (R3), R3 feels their needs are being met at the facility. R3 reported staff being gentle and kind. According to Administrator Unaisi, R1 went to the hospital and never returned to the care facility. The administrator reported she was unaware of where R1 moved and was not informed by the placement agency. Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was held with facility staff, and a copy of report was left at the facility with staff Ilaisa Niutabua.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 27-AS-20240716083150

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required inspection. LPA met with facility staff Eliki Seruvatu, and explained the purpose of the visit. Administrator Unaisi Waqalala was contacted via cell phone by the facility staff. LPA observed one (1) staff and six (6) residents in care. Staff was observed preparing lunch for the residents in care. Today, lunch was pepperoni pizza and salad along with a choice of beverage. Three residents were observed watching television while eating lunch, one in their room watching television, another resident having a family and Chaplin visit, and another resident eating lunch with their family. LPA Valerio and staff E. Seruvatu toured the facility to ensure compliance with Title 22 regulations. LPA observed the front living room space to be clean, furnished, and free from debris. LPA observed five (5) resident bedrooms. Resident bedrooms were clean, furnished, and free from debris or odors. LPA observed one (1) staff bedroom, which was located inside the house. Resident bathrooms were observed to be stocked with paper towels, toilet paper, skid mats, hand rails, soap, hand sanitizer, and a trash can. Hot water was measured at 105.0*F degrees. Technical assistance (TA) was provided for the sink located in the "staff" bathroom. The sink faucet handle was observed to be loose and will need to be repaired. According to staff, residents have access to use the bathroom. The common area and kitchen area was observed to be clean and free from debris. The facility had a food supply to meet the minimum requirements of two (2) days of perishable food items and seven (7) days of non-perishable food items. The kitchen stove was observed to have a missing door handle with a screw sticking out of the door. A picture was obtained for reference. According to staff, staff utilize the smaller conventional oven for every items and only use the large oven as needed. LPA observed sharps, chemicals, and medications to be locked and inaccessible to residents in care. Continues on LIC 809 - C... Continued from LIC 809 LPA observed the garage area. LPA observed the garage to have furniture, a bed with a pillow, a couch, and other storage items. According to staff, the bed is not used for sleeping and utilized as a break area. LPA reviewed the facility sketch submitted during the pre-licensing inspection. The facility sketch submitted along withe the facility sketch posted at the facility does not indicate the garage to be a staff area. A picture was obtained for reference. The facility's last fire drill was conducted November of 2023. LPA observed the fire detector and carbon monoxide detector to be in working condition. The facility fire extinguisher located in the kitchen was observed to be expired as evidenced by the arrow pointing in the red area and a previous annual maintenance of April 04, 2023. Due to this violation, facility staff was informed that the licensee will be cited and an immediate civil penalty will be assessed today in the amount of $500.00. A signature was obtained on the LIC 421IM. LPA reviewed four (4) staff files. 2 out of 4 staff files reviewed were observed to be missing annual training documentation. 4 out of 4 staff files were observed to have a current first aid certificate. LPA reviewed three (3) resident files. 1 out of the 3 resident files reviewed were observed to be incomplete. One resident file was missing their annual Appraisal & Needs and Service Plan. LPA requested the following annual documentation be sent to the Regional Office by 04/29/2024: An updated LIC 500, updated LIC 308, updated LIC 309, updated LIC 610, and a copy of current liability insurance. Per California Code of Regulations (CCR) - Title 22, deficiencies are being cited on the attached LIC 809 - D page. Appeal rights were provided. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 22, 2024

Allegation investigated: Staff inappropriately touched resident

On 2/13/24, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to deliver the findings for a complaint received on 6/9/23. LPA met with facility staff Nepani Tuivu and explain the purpose of the visit. LPA spoke with Administrator Unaisi Waqalala over the phone to discuss the conclusion for complaint and the findings. Administrator Unaisi Waqalala was unable to come to the facility and gave consent for staff to sign today's report. Throughout the course of the investigation, the Department conducted interviews and reviewed records. Based on records review, and staff and resident interviews, there is not a preponderance of evidence to substantiate the allegation mentioned above. The investigation revealed that resident (R1) wasn't sure if staff (S1) was touching R1 for sexual arousal while cleaning R1. R1 reported that S1 never tried to force physically or inserted anything into R1. R1 stated that S1 stopped cleaning R1 when R1 asked S1 to stop. S1 denied touching R1 inappropriately and stated that S1 was only performing caregiver duties when cleaning R1. Continued on 9099-C Unsubstantiated This Department has investigated the allegation noted above and have found the complaint to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and a copy of report was left at the facility.the state’s words, verbatim · CDSS document, Feb 13, 2024 · control 27-AS-20230609170234