Loving Legacy Senior Care II

Type of visit: Case Management - Other

On August 6, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), made an unannounced visit to this facility to amend a report. LPA met with staff on duty Torika Coaa (S1) and Jones Tunidau (S2) explained the purpose of the visit. The Administrator, Veniana Banuve was notified by staff but did not answer the call. LPA requested to review the Administrator Visit Log as agreed during Non-Compliance Conference (NCC) on April 15, 2026. Per S2 he cannot find one. LPA attempted to locate the log in their file closet but LPA was unable to locate it. LPA was unable to review the log during this visit. Since it was not available during this visit, LPA determined the log is not maintained at the facility as agreed during NCC. Today's visit, LPA amended the LIC9099-D page of the report for complaint investigation #27-AS-20260414141418 delivered on July 10, 2026. This amendment did not change the deficiency or its plan of correction. According to the California Code of Regulations, Title 22, deficiencies were observed AND cited during today's visit. LPA reviewed the report and Plan of Correction with S2 during exit interview and provided a new copy of LIC9099-D for their records. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 6, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(a) · Plan of correction due date: Aug 13, 2026

(a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement is not met as evidenced by: Based on interview, record review and observation, the licensee did not comply with maintaining administrator visit log as agreed upon during NCC meeting. LPA and staff did not find the administrator log. Additioinally, the administrator was contacted via telephone but did not respond during this visit. This poses a potential health, safety or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: The licensee will review the NCC meeting report dated 4/15/26 and must submit an acknowledgment of understanding of the what was agreed upon by the licensee during this meeting by POC due date. The administrator must start documenting the her visits as per agreement.

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

On July 23, 2026, at approximately 9 am, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct a follow-up investigation visit regarding the allegations noted above. LPA initially met with Anese Warfield (S4) and stated the purpose of the visit. S4 stated that the administrator, Veniana Banuve (AD), cannot be here at the moment. Present upon arrival were 4 residents in care with one staff on duty, Eparama Musuvanua (S5). According to S5, 2 residents are out in the community. At approximately 10am, another staff arrived who identified himself as Serupepeli Tuidekei (S6). Per review of Guardian, S4, S5, and S6 are currently associated to this facility. {1 of 2} Unsubstantiated Allegation - The facility allowed excluded individuals (E1 and E2) to work in the facility: The investigation into this allegation consisted of interviews, record reviews and observations. During interviews, staff said they had not seen the excluded individuals at the facility. Some staff said they did not know who the excluded individuals were. Residents were also interviewed and said they had not seen the excluded individuals at the facility. Residents were not familiar with the excluded individuals when shown their photos and when their names were mentioned. A review of the Personnel Rosters (LIC500), dated 2/4/2026, 4/8/2026, and 7/13/2026, showed that the excluded individuals were not listed as employees. During observations made on 1/22/2026, 2/18/2026, 4/8/2026, 4/23/2026, 4/24/2026, 7/10/2026, and 7/23/2026, there were no reports or observations of the excluded individuals, E1 and E2, being present at the facility. 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. LPA Villanueva contacted the doctor's office for 5 residents to verify whether the residents had been seen by the physicians who completed their Medical Assessment (LIC 602A) forms. LPA attempted to verify the records for four of the five residents, but the doctor's offices were unable to confirm the information because of their privacy policies. Staff were also interviewed and could not confirm that the administrator, licensee, or management staff had falsified or forged resident documents. Staff said they had not been asked by management to alter or forge any resident documents. 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. AD authorized S6 to conduct the exit interview and sign this report. A copy of this report and appeal rights were provided. {2 of 2} A review of the facility's LIC 500, Personnel Report, dated 2/4/2026 and 4/8/2026, showed the administrator was scheduled to work Fridays, Saturdays, and Sundays from 7:00 a.m. to 5:00 p.m. The most recent LIC 500, dated 7/13/2026, showed the administrator's schedule had changed to Mondays and Tuesdays from 7:00 a.m. to 7:00 p.m. Despite the documented work schedules, the administrator was not present during the majority of LPA visits. Further, records reviewed from the non-compliance (NCC) office meeting held on 4/15/2026 with Administrator/Licensee Veniana Banuve documented the administrator's agreement to be physically present at the facility for at least 40 hours per week, conduct unannounced nighttime health and safety checks at both licensed facilities, and maintain a written administrator presence log documenting the date, time, staff on duty, resident census, and observations made during each visit. During the follow-up inspection on 7/23/2026, the LPA requested this required documentation; however, facility staff were unable to produce any administrator presence log or other documentation verifying compliance with the agreed corrective actions. Additionally, staff interviews revealed inconsistent statements regarding how often the administrator was present at the facility. Some staff reported the administrator visited periodically, while others were unable to state how frequently the administrator was on-site. Several staff members were unable to identify who the facility administrator was. 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. An immediate civil penalty is being assessed today due to repeat violation. Plan of correction and appeal rights were discussed with AD via telephone. AD authorized staff S6 to conduct the exit interview and sign this report. A copy of this report and appeal rights were provided to facility. {2 of 2}the state’s words, verbatim · CDSS document, Jul 23, 2026 · control 27-AS-20260211113932

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Jul 31, 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 interveiws, record reviews and observations, the administrator was not present during 7 of 8 unannounced LPA visits. The facility also did not to provide the required administrator presence log as agreed during the 4/15/2026 Non-Compliance Conference, and the inconsistencies of staff statements. This poses a potential health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 23, 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 as per NCC agreement; may title it Administrator Visit Log. Administrator Visit Log from 7/23/26 to 7/30/26 will be submitted to the Department by POC due date.

Allegation investigated: Licensee did not ensure facility produced records to the appropriate party upon request

On July 10, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct a follow-up complaint investigation regarding the allegation noted above. LPA met with staff on duty, Barbara Hall-Williams (S1) and stated the purpose of the visit. The administrator, Veniana Banuve (AD) was not available to be present during this visit and designated S1 to sign this report. The investigation into the allegation that licensee did not ensure facility produced records belonging to resident (R1) after multiple requests from requester consisted of interviews and record reviews. According to documentation provided to the Department, the requester made ten (10) attempts between February 2, 2026, and April 8, 2026, via tracked mail and voicemail messages, attempting to obtain R1’s records. The facility did not respond and did not produce any records. {1 of 2} Substantiated On June 30, 2026, the administrator stated, through telephone interview, that she “did not received anything” regarding these requests but she confirmed that she will reach out to the requester to resolve this matter. On July 10, 2026, a follow-up attempt with the administrator via email correspondence and a telephone call, regarding the status of the record request and her stated intent to contact the requester. Administrator has not reach out to the requester prior to today. The Department has concluded, based on the preponderance of the evidence obtained during this investigation, that the above allegation is SUBSTANTIATED. The following deficiencies have been cited pursuant to CCR Title 22, Division 6, Chapter 8, Section 87468.2(a)(19). Plan of correction and appeal were discussed during the exit interview with S1. This report and the appeal rights were provided. {2 of 2}the state’s words, verbatim · CDSS document, Jul 10, 2026 · control 27-AS-20260414141418

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Jul 17, 2026

To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. This requirement is not met as evidenced by: Based on interviews and record reviews, the requester made multiple attempts to obtain the records through mails and phone calls but did not received the records. This poses a potential health, safety, and/or personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Jul 10, 2026

Plan of correction: Administrator will reach out to the requester and provide the documents no later than end of day by POC due date.

Type of visit: Required - 1 Year

On July 10, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct the annual inspection. LPA met with staff on duty, Barbara Hall-Williams (S1) and stated the purpose of the visit. The administrator, Veniana Banuve (AD) was not available to be present during this visit. According to S1, today is AD’s day off. Per review of the LIC500 dated 05-11-2026, AD was scheduled Monday through Friday from 7am to 7pm. Present during this visit were five residents in care with two staff on duty, Barbara Hall-Williams (S1) and Donovan Williams (S2). This annual visit is being conducted with a complaint investigation of Complaint # 27-AS-20260414141418. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident units, resident bathrooms, dining room and outdoor areas. Inspection of the kitchen refrigerator – LPA observed a box of injectable insulin belonging to resident. The box is not lockable and is accessible to other residents in care. Cleaning solutions were accessible – Lysol All Purpose Cleaner found inside the bathroom sink in the master bathroom; under the kitchen sink, though it was locked using a bicycle lock, it was still accessible as LPA was able to open it and LPA was able to reach inside the opening; and a purple liquid in a spray bottle placed on the ground outside by the exit gate. Photos were taken. Sliding door in the master bedroom was difficult to slide open (advisory was already provided from previous visit). In the master bathroom, the shower is missing one shower door. LPA is unable to determine the correct temperature of the kitchen refrigerator and freezer during this visit. Advisory was provided from previous visit for facility to obtain a thermometer for each. {1 of 2} Record Review: Review of 5 of 6 resident files was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. Staff on duty (S1 and S2) did not have their health screen in their files. Staff did not have training records related to restricted health conditions for the residents with restricted health conditions. 5 of 5 residents did not have PRN Authorization letter signed by their physician. Resident(s) receiving home health services did not have a written agreement on file. Resident(s) with restricted health condition did not have Restricted Health Care Plan on file. Interviews: 3 residents were interviewed. 2 of 3 stated facility do not provide alternative food or second serving when requested. General Observation: Throughout this visit, LPA did not observed staff offering or conducting activities with residents. Documents Requested: LPA requested a copy of updated Liability Insurance, updated LIC500, and LIC308. Per the California Code of Regulations, Title 22, Division 6, Chapter 8 and/or Health and Safety Code, deficiencies were cited. Facility is hereby assessed immediate civil penalties in the amount of $2000 total due to repeat violations. Plan of correction and appeal procedures were discussed during exit interview with AD. A copy of the report and appeal rights were provided. {2 of 2}the state’s words, verbatim · CDSS document, Jul 10, 2026

The state marks this report as 14 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Type of visit: POC

On April 30, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), conducted an unannounced Plan of Correction (POC) inspection to ensure all previous deficiencies have been corrected and all written plans of correction have been completed. LPA met with the licensee/administrator, Veniana Banuve (AD) and discussed plans of correction. LPA was informed that no written Plans of Correction have been submitted for the deficiency cited on April 23, 2026, with a due date of April 24, 2026, regarding a violation of CCR Section 87203, Fire Safety. Regarding the hot water deficiency, the hallway bathroom hot water temperature was measured at 119 degrees Fahrenheit during this visit. The storage area for sharp objects and cleaning solutions under the kitchen sink was observed to be locked and inaccessible. The food supply was reviewed. LPA observed the refrigerator and freezer to be stocked with perishable food items, including fresh vegetables and fruits. Veniana was reminded to submit the Plan of Correction for the citation issued under CCR 87555(a) on April 24, 2026, which is due today. She was also reminded to submit the POC for the citation due on April 24, 2026. Penalties will continue to accrue until the deficiencies are corrected. Based on today's visit, a civil penalty of $100 per day is hereby assessed from the period of 4/24/26 to 4/30/26 for a total of $700. Exit interview was conducted with Veniana and a copy of this report and LIC421FC were provided. Appeal rights was also provided.the state’s words, verbatim · CDSS document, Apr 30, 2026

Type of visit: Post Licensing

On April 24, 2026, Licensing Program Analyst, Arvin Villanueva (LPA) arrived at this facility unannounced to conduct a case management visit. LPA met with staff on duty, Kirk Campbell (S1), and stated the purpose of the visit. S1 notified the assistant administrator who he identified as "John" but S1 stated he never answered or responded throughout this visit. When LPA asked if S1 know or seen Veniana Banuve, S1 stated he has not since he started working at this facility. S1 stated he only met "John" and "Kim" and identified them as "management." "John" arrived at 3:00 pm. Present during this visit were 5 residents in care with one staff on duty (S1). Fire door was observed to be closed upon arrival. The purpose of this visit is to return the resident (R1), files and staff files that were removed on April 23, 2026, for the purpose of copying files at the Regional Office. Files were handed to S1 during this visit. Additionally, the purpose of this visit is to continue the post-licensing inspection that was initiated on April 23, 2026. Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA and S1 inspected 3 of 5 resident bedrooms and 2 of 2 bathrooms. Hot water temperature was taken in both bathroom – temperature was between 150 and 151 degrees Fahrenheit. In the kitchen, LPA observed 3 kinds of fruits (half a bag of apples, nearly empty container of blue berries, and one whole avocado). LPA did not observe fresh vegetables in the refrigerator. Per review of the sample menu provided by S1, vegetables are included such as green salad, for lunch and cabbage slaw for dinner, as example. {1 of 2} One fire extinguisher was observed in the kitchen area and was last inspected on March 18, 2026. The cabinet under the kitchen sink where they keep cleaning chemicals and sharps was observed to be accessible as evidenced by being secured by a plastic “child proof locking device” but can be unlocked without a key. Per S1, they use this device during the day but uses a lock with a key at night. LPA informed S1 that dangerous items need to be always locked and not accessible to residents in care. Dishwasher was not working during this visit. S1 stated a repair request has been initiated but unsure when it will be done. The garage is not accessible to residents in care, and it is kept locked and can be accessed with a key. The sliding door at the living room/kitchen area leading to the backyard was difficult to slide open. Outdoor area was inspected. S1 was unable to correctly identify, locate. and know how to operate each of the shut off valves. Per S1, he was not oriented on these. Walkway to the exit gate was obstructed by a wood bookshelf/cabinet, a white shower chair, and some type of green ceramic plant pot. Someone who uses a wheelchair would not be able to get through immediately during an emergency. Based on today’s visit, deficiencies are being cited and advisories were provided. Exit interview was conducted with with Veniana over the phone and gave permission to S1 to sign this report. A copy of this report and appeal rights were provided. {2 of 2}the state’s words, verbatim · CDSS document, Apr 24, 2026

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Post Licensing

On April 23, 2026, Licensing Program Analyst, Arvin Villanueva(LPA), arrived unannounced at this facility to conduct the Post Licensing visit. This visit is being conducted concurrently with complaint investigation visits (Complaint #27-AS-20260414141418 & Complaint #27-AS-20260420105215). LPA initially met with staff on duty, Kirk Campbell (S1), and stated the purpose of the visit. Per S1, he notified the administrator but did not arrive during this visit. Upon arrival, LPA observed the fire door to be propped opened with a dining chair (photo taken). Later during the visit, LPA observed S1 removed the dining chair and closed the fire door. During this visit, LPA conducted review of two resident records. LPA conducted facility observation. The sliding door, marked exit, by the kitchen/living room area was difficult to open. It required LPA a bit of a force to slide it open. Advisory was given to ensure the door is easy for residents to slide it open. Based on today's visit, this post licensing inspection requires continuation. The Department will return at a later date to continue the inspection. Deficiencies are being cited today. Immediate Civil Penalties is assessed today in the amount of $1000 due to repeat fire safety violation. Exit interview was conducted a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 23, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Apr 24, 2026

Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Based on observation, upon arrival, LPA observed the fire door was propped open with a dining chair. This poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 23, 2026

Plan of correction: Corrected on site: staff on duty removed the chair and closed the fire door. This is a repeat violation. Last time, they conducted staff training. Per discussion, __ agreed to create a written plan on how facility will implement to ensure the fire door remains closed at all times. Submit plan by April 30, 2026.

Type of visit: Case Management - Legal/Non-compliance

An Non-Compliance Conference (NCC) meeting was held on 04.15.2026 in-person at the Sacramento Regional Office. The purpose of this meeting was to discuss concerns regarding both facilities. Participants in the meeting included: Regional Manager-Stephenie Doub, Licensing Program Manager LPM- Stephen Richardson, Licensing Program Analyst LPA- Shakaricka Hughes, Licensee/ Administrator- Veniana Banuve. During the meeting, an incident which occurred in the facility on 01/24/2026 was discussed in which a resident eloped from the facility without facility staff being aware. Hospice resident care including repositioning schedules, staff working hours and schedules. Administrator presence in the facility. Facility and staff required training. The facility has stated they will agree to do the following: Administrator’s presence in facility 40 hrs. per week, including unannounced night- time health and safety checks in both facilities. The facility will maintain a record of administrator presence, this document will remain at the facility, including date and time, staff present, census, and other pertinent details related to the visit and observations. Submit Personnel Report (LIC500) any time changes are made. Submit Designation of Administrative Responsibility (LIC308) for both facilities and any time changes are made. Continuation 809-C Submit a copy of the Daily Health Check Log by close of business and any time changes are made.The log is to be overseen by Administrator/Designee once every week and/or any time changes occur to include updated re-assessments and communication of such changes by a call to Community Care Licensing (CCL), Conservators and/or responsible parties along with submitting in writing using the Incident report (LIC624). Administrator will conduct vendor training for both on the job training, and annual training. Documentation of the training, including who was present. Administrator will calendar schedule on what dates the training will conducted. The Regional Office (RO) will continue to monitor the facilities’ progress. The RO will continue increased monitoring to verify compliance with issues discussed The RO will revisit compliance in 12 months and begin the legal process if facility is not in compliance. The licensee was Informed that an additional civil penalty was pending review and may be assessed according to Health and Safety code 1569.49(e). Once a civil penalty has been determined, the department will return at a future date to assess civil penalty. A Non-Compliance Conference Summary (LIC 9111) was generated to document this office meeting. A copy of this report and the LIC 9111 was provided to the licensee.the state’s words, verbatim · CDSS document, Apr 15, 2026

Type of visit: Case Management - Deficiencies

On April 8, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct a case management visit to issue deficiencies based on a complaint investigation visit (Complaint #27-AS-20260407081657) conducted on the same day. LPA met with the assistant administrator, Lorima Niumataiwalu (S2), and stated the purpose of the visit. The administrator, Veniana Banuve, was notified but according to S2 she never responded. Regarding the fire door: Throughout this visit, the fire door leading to the kitchen/dining/living room area was propped open by a dining chair. Per review of staff orientation training records revealed that staff were oriented/trained on Building and Fire Safety and appropriate response to emergencies. This training was 2 hours. Per interview with staff on duty, Kirk Campbell (S1), he stated that they keep the fire door propped open during the day and close it at night. Per S2, he stated that one resident has difficulty with opening it due to their walker. S2 admitted that the fire door needs to be closed at all times and corrected this deficiency by removing the dining chair and closing the door at approximately 3:37pm. LPA consulted S1 and S2 that they need to comply with applicable laws and regulations. {1 of 2} A review of California Building Code (CBC) 425.8.3.2 Group R-3.1 Occupancies Housing Nonambulatory Clients states "The hallway shall be separated from the common areas by a solid wood door not less than 13/8inch in thickness, maintained self-closing or shall be automatic closing by actuation of a smoke detector." According to CCR 87405(d)(2), the administrator is expected to have "Knowledge of and ability to conform to the applicable laws, rules and regulations." This include fire safety regulations adopted by the State Fire Marshal. Regarding personnel records: During a review of personnel records, it was revealed that S2's files were not available at this facility for review. Also, S1's Health Screen (LIC503) was missing the second page that include the TB test result. Regarding resident records: During a review of resident records, one resident (R3) did not have their Medical Assessment (LIC602A) and Needs and Services (LIC625) were not on file and not available for review during this visit. This facility is hereby cited per Title 22, Division 6, Chapter 8. Additionally, an immediate civil penalties in the amount of $500 is being assessed today based on fire safety violation. An exit interview was held with Lorima and Plan of Corrections were discussed. Appeal rights and a copy of this report were handed to Lorima. {2 of 2}the state’s words, verbatim · CDSS document, Apr 8, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Apr 9, 2026

Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation, the fire door was propped open with a dining chair throughout this visit. This poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: Corrected on site: after consulting with the assistant administrator, he removed the dining chair. Additional corrective action was discussed with the assistant admin. Per discussioin, they agreed to conduct in-service training with staff and residents to discuss fire safety, including the requirements relating to fire doors. Proof on training shall be submitted to the Department by 4/15/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(g) · Plan of correction due date: Apr 15, 2026

(g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met as evidenced by: Based on record review and interviews, S1's health screen record was missing the second page; and S2's records were not available for review upon request. This poses a potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: Per discussion with assitant admin, the licensee/administrator shall develop a written plan to ensure all personnel records are maintained at the facility and available for review during the Department's visit or upon request by the Department. Written plan shall be submitted by POC due date on 4/15/2026 no later than 5pm.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Apr 15, 2026

(d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement was not met as evidenced by: Based on record reviews and interviews, the licensee did not comply with the regulation cited. R3's Medical Assessment and Needs and Services Plan were not available for review during this visit. This poses a potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: Per discussion with assitant admin, the licensee/administrator shall develop a written plan to ensure all residents' records are maintained at the facility and available for review during the Department's visit or upon request by the Department. Written plan shall be submitted by POC due date on 4/15/2026 no later than 5pm.

Type of visit: Office

An Non-Compliance Conference (NCC) meeting was held on 3/27/2026 at the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss concerns regarding both facilities. Participants in the meeting included: Regional Manager-Stephenie Doub, Licensing Program Manager LPM- Stephen Richardson, Licensing Program Manager LPM-Lisa Rios, Licensing Program Analyst LPA- Arvin Villanueva, Licensing Program Analyst LPA- Shakaricka Hughes, Licensing Program Analyst-Reza Jamaly, and Licensee/ Administrator- Veniana Banuve. During the meeting, an incident which occurred in the facility on 01/24/2026 was discussed and the following records for facility staff (S1) was requested by the Dept by 03/31/2026. Personnel Record for (S1) Training Records for (S1) This meeting has been rescheduled to an in-person office meeting on April 03, 2026 at 10:00 AM at the Sacramento Regional office. An informal invitation was sent via email to the licensee on 03/27/2026. This report was discussed with the licensee, and a copy of this report was provided to the licensee via email.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Office

An informal meeting was held on 2/20/2026 at the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss concerns regarding both facilities. Participants in the meeting included: Licensing Program Manager LPM- Stephen Richardson, Licensing Program Analyst LPA- Arvin Villanueva, Licensing Program Analyst LPA- Shakaricka Hughes, Licensee/ Administrator- Veniana Banuve. During the meeting, the informal conference process, including the administrative process, was explained to the licensee: The current areas of concern were identified as follows: · Incident Reporting · Suspected rough handling · Aware of family’s concern and allowed cameras · Mandated Reporter Training-additional training · Meeting Resident Needs without Impeding on Personal Rights · Any additional oversight · TSP offered Continuation 809-C The facilities will do the following to achieve compliance: · Personal Rights training for all staff, licensee will retrain facility staff on proper handling, supervision, support, and meeting residents’ needs without infringing on personal rights. · Review regulation for incident reporting, licensee will retrain facility staff with training regarding Reporting Requirements. Licensee stated that training for reporting requirements was completed 2/13/2026. · Hire additional facility staff for Loving Legacy Senior Care II 342701698. · Increase Administrator oversight at both facilities. · Review Technical Assistance Program (TSP) resources and request additional assistance when needed. The facilities will provide the following documentation to the regional office: · Reporting requirement training curriculum including staff sign-in sheet and trainer will be provided to the Department by 03/02/2026. · Personal Rights and Resident Care training. Licensee has completed training with resources from a Hospice agency. Training curriculum including staff sign-sheet and trainer will be provided to the Department by 03/02/2026. · Licensee will submit an updated LIC 500/ LIC 308 for both facilities by 03/02/2026. The regional office will do the following: · Continue to collaborate and provide assistance to licensee as needed · Offer TSP services · A link to a list of approved CEU Vendors from the CDSS website was provided to the licensee to research and find vendor-based training for their facilities. Per California Code of Regulations (CCR) - Title 22 - no deficiencies are being cited. An exit interview was held, and a copy of the report was sent via email.the state’s words, verbatim · CDSS document, Feb 20, 2026

Type of visit: Case Management - Deficiencies

On 2/18/2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct a case management visit. LPA met with staff on duty, Cakacaka "Job" Biumaiwai (S1) and Dillon Williams (S2), and stated the purpose of the visit. The Administrator on file, Veniana Banuve (AD), was notified of the visit and is unable to come to the facility at this time. Present during this visit were 5 residents in care with 2 staff on duty. During this visit, LPA conducted a facility observation. LPA toured the facility with S1, including but not limited to the bedrooms, bathrooms, kitchen, and common areas. The following were observed: Inspection of the kitchen, LPA found 2 knives in a kitchen drawer next to the oven. Inspection of the kitchen, LPA found 2 medication pills in a kitchen drawer next to the dishwasher machine. Per interview with S2, it belongs to a resident. LPA advised S2 to destruct the medications because they were contaminated. Inspection of the refrigerator, LPA found half of an avocado that is not stored in a closed container. Inspection of the pantry, LPA found a canned food that is damaged by evidenced of burnt at the side of the can. Inspection of the pantry, LPA observed cobwebs and debris on the floor and the shelves. Inspection of the kitchen cabinet, LPA observed debris in the cabinet for their pots and pans. LPA is unable to determine temperature of the refrigerator and freezer because they do not have a thermometer. Based on today's visit, deficiencies are being cited. Exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 18, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Feb 19, 2026

the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the regulation cited above. During inspection of the kitchen, LPA found 2 knives in a drawer next to the oven. These were accessible to residents in care. This poses an immediate safety, health, personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Corrected on site: Staff on duty immediately put away the knives in a locked drawer. Licensee will retrain staff relating to the cited regulation. Proof of training shall be submitted by 2/20/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Feb 19, 2026

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the regulation cited above. During inspection of the kitchen, LPA found 2 medication pills in a drawer next to the dishwasher machine. These were not locked and were accessible to residents. This poses an immediate safety, health, personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Corrected on cite: Staff on duty immediately destructed the 2 medications. Licensee will retrain staff relating to the cited regulation. Proof of training shall be submitted by 2/20/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(8) · Plan of correction due date: Feb 20, 2026

All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the regulation cited above. During inspection of the kitchen, LPA found damaged (burned) canned food in the pantry. This poses a potential safety, health, personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee will develop a written plan on how they will comply with the cited regulation. Written plan shall be submitted by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(23) · Plan of correction due date: Feb 20, 2026

All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the regulation cited above. During inspection of the refrigerator, LPA found half of an avocado that is not stored in a closed container. This poses a potential safety, health, personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee will develop a written plan on how they will comply with the cited regulation. Written plan shall be submitted by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Feb 20, 2026

All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the regulation cited above. During inspection of the kitchen and pantry, LPA observed cobwebs and debris inside the pantry and debris in kitchen cabinet where they store pots and pans. This poses a potential safety, health, personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Licensee will develop a written plan on how they will comply with the cited regulation. Written plan shall be submitted by POC due date.

Allegation investigated: Lack of supervision resulting resident going AWOL and hit by a car causing multiple injuries.

On 01/28/2026 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with facility staff Aisake Jemesa and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 5. Allegation: Lack of supervision resulting resident going AWOL and hit by a car causing multiple injuries. It was alleged that lack of supervision resulted in a resident going AWOL and subsequently being hit by a car sustaining multiple injuries. This investigation consisted of records review, an interview with the reporting party, statements of the facility administrator, and a facility observation. On 1/28/2026 LPA Hughes conducted an unannounced visit to the facility. During the visit, LPA reviewed the resident record, LIC 602A Physician’s Report for resident (R1) which indicated that R1 is unable to leave the facility unassisted. On 1/27/2026, LPA conducted an interview with the reporting party, who stated that facility staff (S1) and (S2) were unaware of the resident leaving the facility on 1/24/2026. The reporting party further stated that R1 was struck by a car and sustained multiple injuries. Continuation 9099-C Substantiated On 1/26/2026, LPA received a statement from the facility administrator (S1) reporting an incident in which (R1) eloped from the facility on 1/24/2026. LPA was unable to interview facility staff (S2) as staff (S3) stated that (S2) is no longer employed at the facility. During a tour of the facility, LPA observed the auditory alarms were present on the front door and on the resident bedroom (Room 4) sliding door leading to the backyard. However, despite these additional safety measures, R1 was able to leave the facility without staff supervision or awareness. The allegation was observed not in compliance with Title 22 regulation 87464(f)(1) Basic Services. As the facility did not ensure that a resident in care was kept under continuous supervision which resulted in elopement. As a result, this 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. An exit interview was conducted with Aisake and a copy of the LIC 9099, LIC 9099-D pages, and Civil penalties were issued in the amount of $500 per the LIC 421IM and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Jan 28, 2026 · control 27-AS-20260126091653

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jan 29, 2026

87464 Basic Services (f) Basic services shall at a minimum include (1) 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 evidenced by: The facility did not ensure that a resident in care was kept under continuous supervision which resulted in elopement. On 1/24/2026 resident (R1) eloped from the facility, without facility staff awareness, and sustained multiple injuries as they were struck by a vehicle. Which poses in immediate Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 28, 2026

Plan of correction: The licensee will ensure the facility is in compliance with Title 22 regulation 87464 at all times. The licensee will conduct professional training with all facility staff working in the facility on care and supervision, and resident elopement. Licensee will send LPA proof of training by 1/29/2026.

Allegation investigated: Staff financially abused resident.

On 01/22/2026 at 1:30 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility staff Enesi Yavala and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 5. A brief interview with conducted with Enesi. Allegation: Staff financially abused resident It was alleged that staff financially abused a resident. This investigation consisted of interview with the reporting party, the facility administrator and records review. On 08/20/2025, the Dept conducted an interview with the reporting party who reported that resident (R1) was taken to the bank to withdraw $9000.00. An interview with the facility administrator reflected that on 9/1/2025 resident R1 was assisted by the administrator to go to the bank, where R1 received a check in the amount of $8,415.00. The administrator stated that the funds were requested to cover R1’s unpaid board and care charges. Continuation 9099-C Unfounded On 9/26/2025 the Dept, reviewed R1’s financial transactions records, which indicated that R1 was not overcharged for board and care services during the applicable audit period of 07/08/2025 through 09/05/2025. Records review further indicated that the facility underwent a change of ownership in July 2025, with new ownership effective July 07, 2025. Due to the prior facility no longer being in operation, it could not be determined whether any overpayments were made before the change of ownership. This agency has investigated the complaint alleging that staff financially abused a resident. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and is without a reasonable basis.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 27-AS-20250804104940

Type of visit: Case Management - Other

On 01/22/2026 Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to conduct a case management visit. LPA met with facility staff Enesi Yavala and explained the purpose of the visit. The facility administrator was not present during the visit. The current census is 5. The purpose of this visit was to speak with the facility Licensee/Administrator regarding discrepancies identified in the facility Admissions Agreement. During an investigation of a complaint that was filed with CCLD on 08/04/2025 regarding the facility, it was reported that an Admissions Agreement for a former resident contained inconsistencies regarding whether the resident paid board and care charges through private payer or SSI, and the Admissions Agreement contained missing required signatures. LPA attempted to speak with the facility administrator to highlight the errors in the Admissions Agreement and explain to the Administrator the requirements for completing the Admissions Agreement accurately and in its entirety, including clearly identifying the resident payment sources, and ensuring all required parties sign the document. An addition to reviewing Health and Safety §1569.884 Contents of residential care facility admission agreements to ensure clarity of documentation requirements. An exit interview was held with Enesi, and a copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 22, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jan 29, 2026

87506 Resident Records (a) 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 evidenced by: The licensee did not ensure the facility Admission Agreement for resident (R1) was complete as the agreement missed required signatures. Which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 22, 2026

Plan of correction: Licensee will ensure the facility remains in compliance with Title 22 regulation 87506 at all time. Licensee will review all residents records Admissions Agreement for completeness, including required resident and or responsible party signatures. Licensee will send LPA Hughes a statement of acknowledgement and understanding of the Title 22 regulation cited, including a statement that resident records have been reviewed for completeness in the facility by 01/29/2026.

Type of visit: Case Management - Other

On 12/30/2025 at 9:45 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to conduct a case management visit to the facility. LPA met with facility administrator Veniana Banuve. The purpose of this visit is to follow-up on a documentation request by the Dept. The current census is 6 with 1 facility staff. LPA entered the facility and observed (2) residents siting in the kitchen area, LPA observed (3) additional residents in their bedrooms. LPA observed resident room 1 unclean with bottles of urine on the dressers. This was observed not in compliance with Title 22 regulation 87625(b)(3) Managed Incontinence. As the facility did not ensure that the residents bedroom was kept clean and free of odor. During today's visit LPA spoke with the administrator regarding documentation requested by the Dept on 12/26/2025. LPA was able to retain the necessary documentation requested by the Dept. Additionally LPA spoke with the administrator regarding a resident (R1) who temporarily left the facility due to being hospitalized. Resident (R1) is currently residing back at the facility. The facility has an 30-Day Eviction Notice approved by the Dept, and has started legal proceedings to remove R1 from the facility. The facility administrator stated that they will assist the resident in searching for permanent housing, with the placement agency. Additionally, the facility will increase staffing to assist with residents care and needs in the facility by 12/30/2025. An exit interview was conducted with Veniana and a copy of the LIC 809, LIC 809-D and Appeals Rights were provided to the facility.the state’s words, verbatim · CDSS document, Dec 30, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Dec 31, 2025

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by: The facility did not ensure that residents room 1 was kept clean, and free of odor. LPA observed bottles of urine on the residents dressers. Facility staff discarded the waste, and cleaned the room.the state’s words, verbatim · CDSS document, Dec 30, 2025

Plan of correction: The facility will ensure compliance with Title 22 regulation 87625 at all times. The facility will keep the facility clean, and free of incontinent odors at all times. The licensee agrees to employ additional staff to assist with residents care needs. Licensee will send LPA proof of additional staffing... in the facility by 12/31/2025 via email.

Allegation investigated: Staff physically abused resident while in care.

On 12/10/2025 at 9:30 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Veniana Banuve and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 5. A brief interview with conducted with Veniana. Allegation: Staff physically abused resident while in care. It was alleged that staff physically abused a resident while in care. This investigation consisted of interviews with facility staff and residents, and records review. On 10/14/2025 LPA Hughes conducted a visit to the facility and interviewed 1 facility staff who reported being accused of physically assaulting resident (R2). Facility staff (S1) stated that law enforcement had been contacted and responded to the allegation. During an interview with resident (R2), the resident was unable to confirm whether any additional residents observed the incident. Continuation 9099-C Unsubstantiated An interview with an additional resident indicated that they had not observed any residents being physically assaulted in the facility. LPA attempted to interview (2) residents in care but both residents declined to be interviewed. A review of records, including a statement made by law enforcement, showed that resident (R2) could not corroborate who witnessed the assault and did not have any signs of bruising consistent with being physically harmed by facility staff. Due to insufficient evidence this allegation could not be corroborated at this time, the allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation are found to be UNSUBSTANTIATED. A finding that the complaint allegation 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 violation occurred.the state’s words, verbatim · CDSS document, Dec 10, 2025 · control 27-AS-20251013212104

Allegation investigated: Staff does not ensure food of good quality is served to residents in care. Staff allow residents to be left in soiled clothing for extend periods of time. Staff is financially abusing residents in care. Staff does not ensure residents personal property is safely secured. Staff do not prevent resident from entering other residents rooms.

On 12/10/2025 at 9:30 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Veniana Banuve and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 5. A brief interview conducted with Veniana. Allegation: Staff does not ensure food of good quality is served to residents in care It was alleged that staff does not ensure food of good quality is served to residents in care. This investigation consisted of facility observations, and interviews with residents and facility staff. On 12/10/2025 LPA Hughes conducted a visit to the facility, during the visit LPA observed the facility 2-day perishable food supply consisting of fresh fruits, vegetables, breakfast items, water and juices. LPA interviewed 4 out of 5 residents in care who all denied concerns related to food quality. Continuation 9099-C Unsubstantiated Residents stated that the food being served is of good quality and meets their needs. LPA attempted to interview resident (R1) but was unable as they no longer live in the facility. Interview with 1 facility staff (S1) stated that the facility has implemented weekly menus to assist facility staff and residents maintain healthy diets that meet their nutritional and dietary requirements of the residents in care. Due to insufficient evidence, this allegation could not be corroborated therefore the allegation is unsubstantiated. Allegation: Staff allow residents to be left in soiled clothing for extend periods of time It was alleged that staff allow residents to be left in soiled clothing for extended periods of time. This investigation consisted of interviews with facility staff, residents, and facility observations. On 10/14/2025 LPA Hughes conducted a visit to the facility. LPA spoke with 1 facility staff who stated that they have not received any concerns about incontinent care in the facility. Facility staff (S1) stated that 4 out of 6 residents require assistance with showering needs in the facility. Interview conducted with 4 out of 5 residents reflected no reported concerns with facility staff meeting their sanitary and hygiene needs. LPA attempted to interview resident (R1) but was unable as they declined interview with LPA. On 12/10/2025 LPA Hughes conducted a follow-up visit to the facility, during facility observation residents in care appeared clean, groomed, without any noticeable odors. This allegation could not be corroborated due to insufficient evidence, therefore the allegation is unsubstantiated. Allegation: Staff are financially abusing residents in care It was alleged that staff are financially abusing residents in care. This investigation consisted of facility observations, interviews with facility staff and residents, and records review. On 10/14/2025 LPA conducted a visit to the facility, and spoke with 1 facility staff (S1) who stated that the facility does not hold or supervise residents cash resources, S1 further stated that any concerns regarding residents’ property and money missing are addressed and recorded by the facility. Interview with 2 out of 5 residents in care indicated that they have no concerns about facility staff financially abusing them, and that they are aware of the facilities policy of holding no liability for missing money in the facility. LPA attempted to interview 2 additional residents (R1) and (R4) but was unable as both resident declined interview. A review of the facility Admission Agreement indicated that the facility holds no liability for money kept in the facility, the agreement was acknowledged and accepted upon by residents in care. There is no evidence to support this allegation, therefore the allegation is unsubstantiated. Continuation 9099-C Allegation: Staff does not ensure residents personal property is safely secured It was alleged that staff do not ensure residents personal property is safely secured. This investigation consisted of interviews with residents and facility staff, and records review. On 12/10/2025 LPA Hughes conducted a visit to the facility and spoke with 4 out of 5 residents, who all stated they have no concerns with their personal property not being safe in the facility. Interview with 1 facility staff (S1) stated that residents have not raised concerns regarding their personal property not being safe in the facility. S1 stated that all concerns regarding residents personal property being lost or stolen are promptly addressed and documented by facility staff. LPA observed that facility staff utilize the LIC 9060 Resident Theft and Loss Record to track and document residents missing or lost items. Additional review of resident records indicate that resident R1's LIC 621 Client/Resident Personal Property and Valuables indicate that resident (R1) admitted to the facility with (1) mobile device and (1) clothing item entrusted to the facility. Due to insufficient evidence, this allegation could not be corroborated therefore the allegation is unsubstantiated. Allegation: Staff do not prevent resident from entering other residents rooms It was alleged that staff do not prevent residents from entering other residents rooms. This investigation consisted of interview with facility staff and residents, and facility observations. On 10/14/2025 LPA Hughes conducted a visit to the facility, during the visit LPA spoke with 2 out of 5 residents who stated that they have no concerns about residents entering their rooms unannounced. Additional interview with facility staff (S1) reflected that residents are encouraged to socialize with other residents if they are welcome, S1 stated that whenever a resident does enter a resident’s room unannounced they are redirected to leave the residents room. On 12/10/2025 LPA Hughes conducted a follow-up visit to the facility and interviewed 4 of out 5 residents. Of those interviewed, 3 residents reported no concerns with staff not preventing other residents from entering their rooms. LPA attempted to interview resident (R4) but was unable as they declined to be interviewed at this time. Facility observation reflected that all residents were in their own rooms, LPA observed resident (R4) on multiple occasions outside of their own room in the common area watching television. Due to insufficient evidence, this allegation could not be corroborated at this time. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be 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.the state’s words, verbatim · CDSS document, Dec 10, 2025 · control 27-AS-20251013150754

Allegation investigated: Staff do not assist resident with showering Staff do not assist resident with grooming Staff do not assist resident with obtaining medical care Staff do not provide resident with housekeeping Staff do not provide resident with adequate clothing

On 10/14/2025 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Veniana Banuve and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6. A brief interview with conducted with the administrator. Allegation: Staff do not assist resident with showering and grooming needs It was alleged that facility staff do not assist residents with showering needs. This investigation consisted of interviews with facility staff and residents in care. On 10/7/2025 LPA Hughes conducted a visit to the facility, during the visit LPA interviewed 1 facility staff (S1) who stated that 3 out 6 residents require assistance with showering and grooming. LPA also interviewed 5 out 6 residents in care. All interviewed residents confirmed that the facility maintains regular showering schedules and expressed no concerns regarding showering or grooming assistance provided by staff. Additionally, 3 out 6 residents reported being independent with their showering and grooming needs and expressed no concerns. There is no evidence to corroborate this allegation at this time, therefore the allegation is unsubstantiated. Continuation 9099-C Unsubstantiated Additionally, interview with an officer from SPD, stated that resident (R1) did not disclose any details regarding the incident. Interview with resident (R1) could not recall the alleged incident of being sexually abused by facility staff. There is no evidence to prove this allegation occurred therefore the allegation is unfounded. This agency has investigated the complaint alleging staff sexually abused a resident. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened or is without a reasonable basis. Allegation: Staff do not assist resident with obtaining medical care It was alleged that facility staff do not assist residents with obtaining medical care. This investigation consisted of interviews with facility staff, residents in care, and records reviewed. On 10/7/2025 LPA Hughes conducted a visit to the facility, during the visit LPA interviewed 1 facility staff (S2) who stated that the facility provides transportation and scheduling to Medical appts for residents in care, facility staff (S2) stated that residents do not require outside transportation to medical appts. Interview with 2 out of 6 residents in care stated they have no concern with the facility providing assistance with obtaining medical care. During an additional interview, Resident (R3) confirmed that the facility assists residents with transportation to their medical appointments. LPA reviewed the facility Admissions Agreement for residents, which reflected that the facility does provide fee based transportation services for residents in care. There is no evidence to corroborate the allegation. Therefore, the allegation is unsubstantiated. Allegation: Staff do not provide resident with housekeeping It was alleged that staff do not provide residents with housekeeping. This investigation consisted of interviews with facility observation, and interviews with residents in care. On 10/7/2025 LPA Hughes toured the inside of the facility and observed the facility kitchen and dining room clean. On 10/14/2025 LPA Hughes conducted a visit to the facility and observed the facility bathrooms, bedrooms, dining room and kitchen area clean and sanitized. Interview with 3 out of 6 residents in care, expressed no concern with their bedrooms and bathrooms being cleaned regularly. There is no evidence to corroborate the allegation. Therefore, the allegation is unsubstantiated. Allegation: Staff do not provide resident with adequate clothing It was alleged that staff do not provide residents with adequate clothing. This investigation consisted of interviews with facility staff, residents in care, and records review. Interview with facility staff (S1) revealed that residents’ clothing is washed daily. Interview with 3 out of 6 residents reflected residents have no concerns with clothing in the facility. Additional review of the Facility Plan of Operation, does not specify that the facility is responsible for providing clothing to residents in care. There is no evidence to corroborate this allegation, therefore the allegation is unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be 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.the state’s words, verbatim · CDSS document, Oct 14, 2025 · control 27-AS-20250804104940

Allegation investigated: Staff mismanaged resident's medication Staff did not safeguard resident's personal items Staff handled resident in a rough manner Staff does not assist resident with obtaining medical/dental care

On 10/14/2025 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Veniana Banuve and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 6. A brief interview with conducted with the administrator. Allegation: Staff mismanaged residents medication It was alleged that staff mismanaged residents medication. This investigation consisted of records reviewed, and interviews with residents. On 9/2/2025 LPA Hughes conducted a visit to the facility. LPA reviewed 3 out of 6 medications and the Medication Administration Record (MAR) was observed complete. Interviews with 5 out of 5 residents in care reflected no concerns with medication administration in the facility. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore unsubstantiated. Continuation 9099-C Unsubstantiated Allegation: Staff did not safeguard residents personal items It was alleged that staff did not safeguard residents personal items. This investigation consisted of interview with the reporting party, interview with facility staff and interview with a resident in care. Interview with reporting party indicated that the allegation was no longer valid. Additional interview with facility staff stated that residents concerns about items missing in the facility are promptly addressed, facility staff stated that R1 concerns of missing items were not related to items being stolen in the facility. Interview with R1 revealed that they have no concern about items being stolen in the facility. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore unsubstantiated. Allegation: Staff handled resident in a rough manner It was alleged that staff handled resident in a rough manner . This investigation consisted of interview with facility staff and residents in care. On 10/7/2025 LPA Hughes conducted a visit to the facility and interviewed 1 facility staff and 4 out of 6 residents in care. Interview with facility staff (S1) indicated that staff deny allegations of handling a resident in a rough manner. Interview with 4 out of 6 residents indicated that residents have no concern about staff handling a resident in a rough manner. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore unsubstantiated. Allegation: Staff does not assist resident with obtaining medical/dental care It was alleged that staff does not assist residents with obtaining medical/dental care. This investigation consisted of interviews with facility staff, residents in care, and records review. On 10/7/2025 LPA Hughes conducted a visit to the facility and interviewed 1 facility staff and 4 out of 6 residents in care. Interview with facility staff (S2) reflected facility staff are responsible for scheduling appointments for residents, and transportation services. Records review of the facility Admission agreement states that the facility does provide fee-based transportation services for residents in care. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore unsubstantiated. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be 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. As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with the facility administrator Veniana and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.the state’s words, verbatim · CDSS document, Oct 14, 2025 · control 27-AS-20250822195248

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Oct 17, 2025

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: Licensee did not ensure that food being served in the facility was of good quality. LPA observed residents consuming breakfast items that were not considered healthy food choices.the state’s words, verbatim · CDSS document, Oct 14, 2025

Plan of correction: Licensee will ensure the facility is in compliance with Title 22 regulation 87555. Licensee will ensure that all meals, including breakfast meet nutritional needs of all residents in care. Licensee agrees to create a menu that is consistent with the nutritional needs and dietary needs of all residents in care. Licensee agrees to send proof of the facility menu and acknowledgment of the regulation by 10/17/2025 via email to LPA Hughes.

Type of visit: Case Management - Other

On 10/14/2025 Licensing Program Analyst (LPA) Shakaricka Hughes conducted a visit to the facility. The purpose of the visit was to conduct a case management visit. LPA met with the facility designated administrator/licensee Veniana Banuve. The current census is 6. During today's visit, it was determined that the facility administrator did not meet the minimum qualifications as required under Title 22 RCFE regulation 87405(a) Administrator Qualifications and Duties. Additionally, observations and staff interviews indicated that the facility was operating with insufficient staffing to meet the needs of all residents in care. The lack of adequate staffing presents a potential risk to residents health and safety as it may limit staff's ability to provide timely assistance with activities for daily living, and supervision of residents in care. The administrator Veniana acknowledged the need to ensure that sufficient qualified staff are present in the facility at all times to meet the residents care needs. The administrator agrees to increase staffing levels in the facility, including being present in the facility as the administrator for a sufficient number of hours to permit adequate attention to the management and administration of the facility. An exit interview was conducted with Veniana, and a copy of the LIC 809, LIC 809-D, and Appeals Rights were provided to the facility.the state’s words, verbatim · CDSS document, Oct 14, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Oct 17, 2025

87405 Administrator Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and 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 evidenced by: The licensee did not ensure that the facility had sufficient staffing levels to ensure the health and safety of all resident in care.the state’s words, verbatim · CDSS document, Oct 14, 2025

Plan of correction: Licensee will ensure the facility is in compliance with Title 22 regulation 87405(a). Licensee will review regulations and provide a statement of acknowledgement and understanding of the regulation. Licensee agrees to increase staffing levels, including being present in the facility as the administrator for a sufficient number of hours to permit adequate attention to the management and administration to the facility. Licensee agrees to submit proof of increased staffing levels, LIC 500 Personnel Report, and a statement of understanding of the regulation to LPA Hughes by 10/17/2025.

Type of visit: Case Management - Incident

On 9/4/2025 at 12:00 PM, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to conduct a case management regarding an elopement incident report received by the Dept on 9/3/2025. LPA met with facility staff Ula and the facility administrator Veniana Banuve. LPA explained the purpose of the visit. The current census is 6 residents with 1 facility staff. LPA interviewed facility staff, regarding (2) separate incidents of elopement on 9/3 and 9/4/2025. Based on interview on 9/3/2025 facility staff was assisting another resident with changing their undergarments. Facility staff seen two residents R1 and R2 standing outside with their bags and a walker. Facility staff tired to redirect residents back into the facility. Staff contacted the administrator Veniana to assist with the residents leaving the facilities. Facility staff ran down the street to try to redirect residents but was unable to have the residents follow them back into the facility. Facility staff contacted R1's Responsible Party (RP) who was able to talk with both residents and persuade them to come back into the facility. On 9/4/2025, resident (R2) asked facility staff if they could go to Walmart and to the Bank. Facility staff told the resident that they had to wait until the administrator came to transport them. The resident spoke with the administrator and facility staff who warned against leaving the facility unassisted. However resident (R2) still left the facility despite being warned not to leave. R1 and R2's LIC 602, Physician Report was reviewed by LPA Hughes and it revealed that Resident (R1) and (R2) is unable to leave the facility unassisted. Interview with Administrator revealed the facility's internal plan includes providing supervision for all residents in care, including transportation to and from appointments. Continuation 809-C Per administrator, Law enforcement was contacted to report the missing resident, and a report will be sent to CCLD to report the incident of elopement on 9/3/2025 and 9/4/2025 at the facility. As of 9/4/2025 R2 has eloped from the facility for the second time, and at the time of this report R2 has not returned. Based on today's case management, a citation is issued under Title 22, Division 6. An immediate civil penalty in the amount of $500 is issued for the dates of 9/3/2025 and 9/4/2025 due to absence of supervision. An exit interview was conducted with administrator Veniana Banuve. A copy of this report LIC 809, LIC 809-D, LIC 421IM and appeal rights was provided to Veniana at the end of the visit.the state’s words, verbatim · CDSS document, Sep 4, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Sep 5, 2025

87464 (f)(1) Basic services care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: Based on interviews with facility staff. The facility did not provide adequate care and supervision which resulted in R1 and R2 eloping from the facility on 9/3/2025. Additional elopement of R2 on 9/4/2025. This posed an immediate health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Sep 4, 2025

Plan of correction: Licensee agrees to submit a plan of correction to LPA by 9/5/2025 on how the facility will be in compliance with regulation 87464(f)(1) at all times. Administrator will read the regulation cited and provide LPA Hughes a letter of acknowledgement that the regulation cited was reviewed. Additionally, Administrator agrees to conduct basic services training for all staff by 9/12/2025 and email LPA Hughes proof of training for all facility staff.

Type of visit: Case Management - Other

On 7/31/2025 Licensing Program Analyst (LPA) Shakaricka Hughes, conducted a case management visit to the facility. LPA spoke with the administrator Veniana Banuve. The current census is 6 with 1 facility staff. LPA conducted a tour of the facility, and it was observed clean, and in good repair. LPA interviewed 4 out of 6 residents in care. During in interview with the facility administrator, she has started the process with the Technical Assistance Program (TSP). Administrator has started reassessing and updating the files of the residents in care. LPA observed a new care staff present in the facility, LPA checked the background clearance and association of the facility staff in Guardian, facility staff was cleared and associated to the facility. LPA spoke with the administrator about reporting requirements for incident reports submitted to CCL, administrator understands the process and accuracy required when submitting incident reports. Administrator states that training for new care staff has started, and when training is completed administrator will send proof of training to LPA. An exit interview was conducted, and a copy of this report was provided to facility at the end of this visit.the state’s words, verbatim · CDSS document, Jul 31, 2025

Type of visit: Prelicensing

On 7/2/2025 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes and Pang Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Hughes met with Administrator Veniana Banuve. Licensee assisted LPA Hughes in today’s inspection. This Applicant is seeking licensure for a (6) non ambulatory Residential Care Facility for the Elderly (RCFE) to accept and retain at any given time. The facility will have 2 staff, 1 of which will be a live-in care staff. There are 5 residents at this time. Veniana Banuve will be the Administrator of this facility. The facility administrator’s certificate # 7030527740 and will expire 04/19/2027. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval. The facility fire clearance has been approved as of 6/24/2025. LPA Hughes toured the facility, Residents’ bedrooms were observed, and furniture and furnishings were observed to be sufficient and able to meet the needs of the residents. LPA Hughes inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time. Silverware, plates, and utensils were observed to be sufficient to meet the needs of the residents at this time. Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the residents at this time. Continuation 809-C The food storage unit, facility refrigerator, was observed to be functional and in good repair at this time. Food supplies were reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed sufficient at this time. The living room and dining area were observed to be furnished and sufficient to meet the needs of the residents at this time. LPA Hughes observed a telephone made available to residents in the kitchen. The facility smoke detectors, carbon detectors and fire extinguisher were observed to be in good condition. The fire extinguisher was last serviced on 08/20/2024. Linen closet was observed with a sufficient supply of sheets, bedding, pillowcases, and blankets to meet the needs of the residents at this time. The water temperature measured at 121.4 degrees Fahrenheit, and the facility temperature measured at 73 degrees. LPA Hughes observed the centrally stored medication areas to be locked. LPA Hughes inspected the first aid kit, and it was complete with all required components. Emergency flashlights, and batteries were observed sufficient at this time. Resident records, staff records, were observed in a hallway closet locked and inaccessible to residents in care. LPA reviewed 5 out of 5 resident files and they were complete. LPA reviewed 2 staff files, and it was complete. LPA reviewed staff criminal record clearances, and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared LPA Hughes, toured the outside of the facility, and observed outside area enclosed by a fence, stairways, inclines, and outdoor passageways, and self latching side gate was observed free of obstruction, and accessible to residents in care. Outside activity area is equipped for activity outdoor use. LPA toured the garage area, and observed resident hygiene items, cleaning chemicals, toxins, and other supplies located above the washer and dryer. Washer, Dryer and water heater was observed to be in good repair at this time. LPA Hughes discussed and recommended the Technical Support Program (TSP) to the applicant. Veniana, the applicant expressed interest in being recommended to the program. LPA Hughes advised the applicant that a referral to TSP will be completed. Based on a review of this facility during this Pre-licensing visit, it was determined that this facility was found to be in compliance at this time. The applicant has passed the pre-licensing component III of the application process. LPA Hughes will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report has been provided to the facility.the state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Prelicensing

On 6/18/2025 at 9:00 AM, Licensing Program Analyst (LPA) Shakaricka Hughes and Licensing Program Manager (LPM) Czarrina Camilon-Lee arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA Hughes met with Administrator Veniana Banuve. Licensee assisted LPA Hughes in today’s inspection. This Applicant is seeking licensure for a (6) non ambulatory Residential Care Facility for the Elderly (RCFE) to accept and retain at any given time. The facility will have 2 staff, 1 of which will be a live-in care staff. There are 5 residents at this time. Veniana Banuve will be the Administrator of this facility. The facility administrator’s certificate # 7030527740 and will expire 04/19/2027. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval. The facility fire clearance has not been approved as of 6/18/2025. LPA Hughes toured the facility, Residents’ bedrooms were observed, and furniture and furnishings were observed to be sufficient and able to meet the needs of the residents. However, it was observed that residents rooms 1, 2, 4, window screens need replacement, and walls need cleaning. LPA Hughes inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time. Silverware, plates, and utensils were observed to be sufficient to meet the needs of the residents at this time. Knives, cleaning agents, and bleach were observed to be locked and made inaccessible to the residents at this time. Continuation 809-C The food storage unit, facility refrigerator, was observed to be functional and in good repair at this time. Food supplies were reviewed for adequate 2-day perishables and 7-day non-perishable quantities, and they both were observed sufficient at this time. The living room and dining area were observed to be furnished and sufficient to meet the needs of the residents at this time. LPA Hughes observed a telephone made available to residents in the kitchen. The facility smoke detectors, carbon detectors and fire extinguisher were observed to be in good condition. The fire extinguisher was last serviced on 08/20/2024. Linen closet was observed sufficient supply of sheets, bedding, pillowcases, and blankets to meet the needs of the residents at this time. The water temperature measured at 121.4 degrees Fahrenheit, and the facility temperature measured at 73 degrees. LPA Hughes observed the centrally stored medication areas to be locked. LPA Hughes inspected the first aid kit, and it was complete with all required components. Emergency flashlights, and batteries were observed sufficient at this time. Resident records, staff records, were observed in a hallway closet locked and inaccessible to residents in care. LPA Hughes, toured the outside of the facility, and observed outside area enclosed by a fence, stairways, inclines, and outdoor passageways, and self latching side gate was observed free of obstruction, and accessible to residents in care. Outside activity area is equipped for activity outdoor use. LPA toured the garage area, and observed resident hygiene items, cleaning chemicals, toxins, and other supplies located above the washer and dryer. Washer, Dryer and water heater was observed to be in good repair at this time. Licensee/Administrator will ensure that fire clearance is completed once new fire clearance is approved. Licensee/Administrator will ensure that compressed gas tanks are removed from the facility Licensee/Administrator will ensure that residents bedrooms 1,2,4, have new window screens Licensee/Administrator will ensure that residents bedrooms 1, 2,4,5 walls are cleaned, including entry way hallways. Licensee/Administrator will ensure that resident bedroom 5 room closet, behind door needs to be cleaned and free of odor Licensee/Administrator will ensure that resident bedroom 1 room is free of odor The Applicant has not passed the pre-licensing component of the application process. The applicant will correct issues and inform LPA when the corrections have been completed. An exit interview was conducted, and a copy of this report was provided to the Applicant.the state’s words, verbatim · CDSS document, Jun 18, 2025