Love and Serenity II

Allegation investigated: Staff are forging resident documents.

Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on July 16, 2026, at 11:03 AM to deliver complaint findings, LPA Martinez met with Luisa Biu and explained the purpose of the visit. Throughout the course of the investigation, LPA Martinez conducted interviews, reviewed facility files, and conducted facility inspections. Based on a file review, LPA Martinez observed that five out five LIC 602 Physician's Report For Community Care Facilities (LIC602) documents contained physician signatures. In addition, the five LIC602 documents were maintained and completed. As a result, there were no discrepancies observed on the five LIC602 documents. 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 did or did not occur, and therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 16, 2026 · control 27-AS-20260211094606

Allegation investigated: The Administrator is not present at the facility for a sufficient amount of time.

Licensing Program Analysts (LPAs) Avelina Martinez and Sulma Lopez arrived at the facility unannounced on July 01, 2026, at 9:30 AM to deliver complaint findings, LPAs met with Luisa Biu and explained the purpose of the visit. Throughout the course of the investigation, LPA Martinez conducted interviews and reviewed facility files. Based on interviews and facility inspections conducted during this investigation, it was learned that the Administrator does visit the facility weekly. LPA Martinez visited the facility Feburary 20, 2026, June 05, 2026, and July 01, 2026. During these visit, the Administrator was not present. In addition, during an interview, LPA Martinez asked interviewee 1 (I1) how many times has the administrator visited the facility since thier last inspection visit on June 06, 2026? I1 reported zero times. Continued... Substantiated As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D page, per Title 22 Regulations. An exit interview was conducted, and a copy of this LIC 9099 report, LIC 9099-D page, and LIC appeal rights document were provided to the facility.the state’s words, verbatim · CDSS document, Jul 1, 2026 · control 27-AS-20260211094606

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Jul 15, 2026

87405(a) Administrator Qualifications and Duties: ...The administrator...shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility... This requirement was not met as evidence by: based on observation and record review, the Licensee did not ensure the Administrator was present at the facility the sufficient amount of hours to manage the facility. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: The facility administrator shall be present at the facility 40 hours per week starting July 02, 2026, and LIC 500 Personnel Report with updated hours shall be emailed to LPA Maritinez by POC date July 15, 2026.

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Avelina Martinez and Sulma Lopez arrived at this facility unannounced on July 01, 2026, at 9:30 AM to conduct a case management visit. LPAs met with Luisa Biu and explained the purpose of the case management visit. The purpose of the visit today, is in response to learned Incidental medical and dental and basic services deficiencies. Based on four out of five interviews it was indicated that there is one non-awake staff during the night shift. Resident 2 (R2) reported during one night incident, they required a brief change. R2 reported they had to scream for assistance, however, the night staff on duty did not respond. R2 reported they had to wear a soiled brief until a family member arrived at the facility the next day in the morning. Resident 3 (R3) reported that resident 4 (R4) fell while they were in the restroom at night. R4 was yelling for assistance, however the staff on duty did not respond to R4's yelling. R3 reported the staff on duty was not awake at the time of the incident. Resident 1 (R1) and resident 5 (R5) both reported that the night staff is not awake, and they have to yell from their bedroom when they need care and assistance. Both R1 and R5 reported that night staff does not respond to them when they yell for help and care assistance. LPA Lopez conducted a medication administration record (MAR) review for R1. R1's MAR was missing the following medication entries: Budesonide Formoterol 80 inhaler entry, Doxycycline Hyclate 100 MG, and Benzonatate 200 MG Capsul. It is unknown if facility staff have been administering these medications. It was also learned that the facility does not have prescription orders or discontinuation orders for these medications. Continued... R4 has medication prescription orders for the following medication: Carboxymethylellulose 0.5%, brimodine 0.2%, dorzolamide 2 %, Latanoprost 0.005%, Pantoprazole 40 MG EC Tab, Sulfamenthoxazole 400MG/80MG Tab. However, the facility does not have a supply of the medications. The medication orders are a result of a June 02, 2026 medical appointment. R4 has a prescription order Budesonide/Formoterol 160 mcg, and the facility has a supply of the medication. However, the medication is not listed on R4's MAR, and it is unknown if R4 is being administered the medication. It was also learned that R4's Prednisone 5MG is not being administered as ordered. The Prednisone medication bottle states,"Take 5 tablets by mouth once a day., start taking 25 MG daily on August 05, 2025, decrease dose by 5 MG every week." The pill supply started at 105 tablets and as of July 01, 2026, there are 54 pills left. As a result, facility staff are not administering the medication as ordered. As a result, of this visit, the following deficiencies were cited per Title 22 Regulations: 87464(f)(1) Basic Services Basic services and 87465(a)(4) Incidental Medical and Dental. The deficiencies can be found on the 809-D Page. An exit interview was conducted, and a copy of the 809 Report, 809-D Page, and Appeals Rights document were provided to the facility.the state’s words, verbatim · CDSS document, Jul 1, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jul 2, 2026

87464(f)(1) Basic Services Basic services shall at a minimum include:Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: Based on interviews and file reviews, the Licensee did not ensure residents needs were being met during the night shift. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: Facility staff agrees to email signal system and awake night schedule plan by 07/02/2026. Facility staff agrees to implement a signall system, and to have an awake staff that can meet the residents' needs at night. Facility staff agrees to email LIC 500 Personnel Report and singal system purchase receipt and pictures of installed signal system. By July 14, 2026 5:00 PM.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(a)(4) · Plan of correction due date: Jul 14, 2026

87465(a)(4) Incidental Medical and Dental Care: A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidence by: based on file review and interviews, the licensee did not ensure facility staff were assisting R4 with their medication management and administration.the state’s words, verbatim · CDSS document, Jul 1, 2026

Plan of correction: Facility staff agrees to conducted a medication audit by my a medical professional by POC date July 14, 2026. Medication audit documentation shall be emailed to LPA Martinez by POC date July 14, 2026 by 5:00 PM.

Type of visit: Required - 1 Year

On 1/23/26 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Love and Serenity II for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Unaisi Waqalala and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor and clean. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA observed the dress in one bedroom has broken drawers and is in need of repair/replacement. LPA measured the water temperature, temperature measured at 112 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient two day perishable food supplies LPA inspected non-parishable food supply and dry goods and observed several items that are expired. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medication area. LPA observed medications in the fridge in an unlocked box. LPA reviewed Medications and medication administration records. LPA observed several deficiencies in medication administration including, missed medications because the facility ran out of medications and had no refills, no documented medication training and competency examination. LPA observed medications still present that were prescribed in 2024 and have expired. LPA observed medications with altered labels that were not altered by a the pharmacy. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 23, 2026

Type of visit: Case Management - Other

On 8/28/25 at 11:00am, Licensing Program Analysts (LPAs) Kevin Gould and Cynthia Tamayo conducted an unannounced Case management inspection at Love and Serenity II RCFE to deliver an immediate exclusion for a staff member associated to this facility. LPAs met with staff member Merelisoni Mataitoga to discuss the purpose of our visit. LPAs served the facility an immediate exclusion order for staff member R1 (See confidential names list, LIC 811 dated 8/28/25. LPAs obtained a current staff roster dated 7/16/25 to verify R1 is not currently on the schedule. Per staff statements the individual no longer works at the facility. Please removed the individual from being associated with this facility. Per California code of Regulations, Title 22, no deficiencies are observed or cited during today's inspection. Exit interview conducted and a copy of this report were left at the facility.the state’s words, verbatim · CDSS document, Aug 28, 2025

Allegation investigated: Unlawful Eviction

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Love and Serenity II RCFE on 5/28/25 at 2:00pm to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with staff, Merelisoni Mataitoga and together discussed the investigation details. Based on LPA observations during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. The RP did not have direct contact with (R1) and had no direct knowledge of R1 being evicted from the facility. Staff interviewed provided statements that R1 did not want to live at this facility and was under the impression she would be placed in a skilled nursing environment. Both staff interviewed provided statements that R1 asked to be sent to the hospital and informed paramedics not to tell the facility which hospital and she did not want to return. This information was corroborated by the placement agent for R1 who provided statements to LPA that R1 did not want to live at the facility and was not aware of any eviction by the facility. All staff interviewed denied the allegation. Report continued on LIC 9099-C Unsubstantiated Additionally, the placement agent, facility staff and RP have no current knowledge of R1's whereabouts. LPA could not conduct an interview with R1. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Eviction/Discharge are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 28, 2025 · control 27-AS-20250411121517

Allegation investigated: Staff did not properly store resident's medication Hazards were made available to residents in care Staff did not ensure sufficient healthy food items were made available at the facility for residents in care Staff did not provide adequate activities to residents in care Facility is in disrepair

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Love and Serenity II RCFE on 5/28/25 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA Gould met with staff, Merelisoni Mataitoga and together discussed the investigation details. Based on LPA observations during the investigation process and statements obtained during the investigation process, LPA Gould was unable to corroborate the allegations. Both LPAs Lee and Gould observed medications being stored inaccessible to residents in care and were not stored with other items or chemicals that would pose a hazard to residents in care. LPAs also observed all cleaning supplies locked and inaccessible to residents in care. LPA did not observe any hazards accessible to residents in care. LPAs Lee and Gould observed an adequate supply of health and fresh foods available to residents. Three residents interviewed provided statements that the food quality is good and there is plenty of food and snacks available. Report Continued on LIC 9099-C. Unsubstantiated LPA reviewed resident files and medication administration records. LPA observed one resident (R1's) file was incomplete and did not include all required documents. LPA did not observe an admission agreement, emergency information, personal rights forms, needs and services plan or consent forms in R1's file. LPA only observed a physicians report and pre-placement appraisal in R1's file. Additionally, LPA observed errors in documentation of medication administration for multiple residents. LPA observed some medications had not been marked as administered or were marked as given daily when only administered once per week. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegations of records keeping and physical pant are substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home. The Department has investigated the complaint alleging Physical plant. Based on the investigative interviews, record reviews and other supportive evidence, the complaint is determined to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The Complaint has been dismissed. There are no deficiencies cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff and a copy of this report was left at the facility. LPAs did not observe the facility in disrepair and LPAs observed a variety of activities available to residents. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of physical plant, food services and other are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 28, 2025 · control 27-AS-20250313142540

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: May 29, 2025

Personal Accommodations and Services: ll outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by LPA observations the gate latch is on the exterior of the gate and could not easily be opened as a string that attached to the lock is no longer accessible inside the gate. LPA also observed the pavers below the gate are obstructing opening the emergency exit gate which poses an immediate health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 28, 2025

Plan of correction: facility has agreed to ensure the gate can be easily opened from inside the back yard and will ensure the gate can be easily opened and not obstructed by paver below. POC due date is 5/29/25.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: May 29, 2025

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by LPA review of medication administration records indicates errors in documentation as some medications were not documented as being administered and other resident's medications that are given once a week are being documented as being administered daily which poses an immediate health, safety or personal rights risks to residents in care.the state’s words, verbatim · CDSS document, May 28, 2025

Plan of correction: Facility has agreed to retraining for all staff members who assist residents with medications. Documentation of training and training materials used will be sent to the department by the POC due date of 5/29/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jun 6, 2025

Resident Records: The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidence by LPA review of resident records where LPA observed R1 did not have a complete file including admission agreement, consent forms and needs and services plan which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 28, 2025

Plan of correction: Facility has agreed to provide a written plan of correction with the specific steps the administrator will take to ensure all resident files are complete, signed and present at the facility at all times. POC due date is 6/6/25.

Type of visit: Case Management - Deficiencies

On 5/28/25 at 1:00pm, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced case management inspection to address deficiencies observed during an unrelated complaint investigation. LPA reviewed resident medications and medication administration records for all residents. LPA observed two residents (R1 and R2) had each run out of one medication and there were no refills of the medications available at the facility. LPA also observed the staff member present had marked the medications as administered to each resident. Per staff statements the medications have been ordered but have not yet arrived at the facility. Per California Code of Regulations, Title 22, the following deficiency is cited. Exit interview conducted and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, May 28, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: May 29, 2025

Incidental Medical and Dental Care: Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by LPA observations and staff statements that two residents each ran out of one medication and were not administered to each resident as the refills have not arrived and the resident's missed a medication dose although it was marked as adminsitered which poses an immediate health, safety or personal rights risk to resdients in care.the state’s words, verbatim · CDSS document, May 28, 2025

Plan of correction: Facility has agreed to develop a medication refill calendar or notebook where staff members and the administrator can intake medications and identify a refill date to ensure medications do not run out and are given to residents according to physician instructions. A copy or written plan of the medication refill calendar or notebook will be provided to LPA by the POC due date of 5/29/25.

Type of visit: Required - 1 Year

On 1/3/25 at 12:50pm Licensing Program Analyst (LPA) Kevin Gould arrived at Love and Serenity II for the purpose of conducting a required 1 year annual inspection. LPA met with staff, Mere Racule and together conducted a tour of the home. LPA and staff evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture. LPA did observe several rooms in the home to have lighting that was not functioning as designed including the laundry room, resident bathroom, bedroom and hallway lights. LPA measured the water temperature, temperature measured at 118 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA reviewed staff and resident files. LPA observed one staff member present did not have a completed health screening report or TB clearance. LPA observed the training records to be incomplete and the training materials do not meet requirements in terms of care of persons with dementia as the training did not consist of enough training hours to meet regulations. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Feb 3, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced case management visit on 11/22/2024. This visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES. LPA met with caregiver Temo Okomatebula and stated the purpose of visit. Facility understands this is an Immediate Exclusion effective 11/21/2024 and S1 is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility. Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.the state’s words, verbatim · CDSS document, Nov 22, 2024

Allegation investigated: Staff do not prevent smoking marijuana on the facility grounds

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Love and Serenity II RCFE on 5/8/24 at 8:30am to inform the licensee of complaint allegation mentioned above. During this investigation LPA Gould interviewed S1 and R1 (See confidential name list LIC-811 dated 5/8/24).Based on the interviews and statements obtained during the investigation process, the allegations are substantiated because S1 admitted to LPA that a personal visitor of S1 visitor staff at the facility and the visitor smoked marijuana outside the facility. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of Personal Rights is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the home. Substantiatedthe state’s words, verbatim · CDSS document, May 8, 2024 · control 27-AS-20240506102617

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: May 13, 2024

Personal Rights of Residents in All Facilities: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by statements from S1 that a personal visitor came to the facility and smoked marijuana outside the facility which poses a potential health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2024

Plan of correction: Facility will conduct training for all staff members reminding staff that they are not permitted personal visitors while at work and training that smoking marijuana while at the facility is a violation and could result in exclusion from licensed facilities. documentation of training for all staff to be completed and submitted by the POC due date.

Type of visit: Required - 1 Year

On 1/3/24 at 12:30pm Licensing Program Analyst (LPA) Kevin Gould arrived at Love and serenity II for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Lina Tuiloma and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 106 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, Current Administrator Certificate and Client Roster Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 3, 2024