Abounding Peace III Elderly Care.

On June 10, 2026, Licensing Program Analysts Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPAs met with the assistant administrator, Esther Tabua (S1) and stated the purpose of the visit. The administrator, Unaisi Wagalala (AD) was notified and stated she is not feeling well today and designated S1 to assist with the annual and sign this report. Overview : Facility is a one-story home located in a residential neighborhood. Facility is licensed to serve up to 6 elderly residents, up to 6 may be non-ambulatory. Facility has a clearance for 1 bedridden room (Room #5 on the facility sketch). Facility does not have clearance for delayed egress, and locked exterior/interior. Physical Inspection : Areas inspected include, but not limited to, the kitchen, resident units, resident bathrooms, dining room and outdoor areas. LPA and S1 inspected 5 of 5 resident bedrooms and 3 of 3 bathrooms. Hot water temperature was measured at 108 to 110 degrees Fahrenheit. During inspection of the bathrooms, LPA observed one of the bathroom (next to Room #1), the shower tub does not have a grab bar installed, and cleaning solutions and sprays were observed under the sink (photo taken) – accessible to residents. The bathroom at the other hallway, next to Room #3, one of the grab bars was loose and the doorknob was observed to be taped which prevents residents from locking the bathroom for privacy (photo taken); also in this bathroom, LPA found a cleaning spray (photo taken) in the medicine cabinet, accessible to residents in care. Inside Room #4, LPA observed a cleaning spray (photo taken) and next to it was Pepto Bismol (photo taken); the bedside table, LPA observed a bottle of Multivitamin (photo taken). This room belongs to resident (R5). Per review of R5’s Medical Assessment (LIC602A) dated 8/23/25, R5 is not able to administer own medications. This room can be accessed by other residents who per their LIC602As, they were assessed to be at risk if they have direct access to cleaning solutions, vitamins, and other similar and dangerous items. Per observation, S1 immediately put away these items as instructed by LPA Villanueva. {1 of 2} 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Hallway temperature was maintained at 72 degrees Fahrenheit during this visit. Fire door was observed to be closed. Advisory was provided to rearrange their couch in the family room because it was observed to be partially blocking the exit door to the backyard (photo taken). In the kitchen area, LPAs observed at least 7-day nonperishable and 2-day perishable food supplies. Refrigerator and freezer were within regulatory temperature. Knives/sharps were locked in a drawer. Fire extinguishers observed and last serviced on 3/31/2026. Smoke detectors were observed throughout and at least one carbon monoxide detector was observed. Medication cabinet was observed to be locked and not accessible to residents. Outdoor area was inspected. One of the walkways was observed to be obstructed by plants (photo taken). Fences were observed to be in good repair at this time. One of the exit gates needs to be repaired as the bottom was dragging as LPA tried to open it. No bodies of water were observed at this time. There is a shaded area for outdoor activities. LPA observed outdoor furniture. S1 was unsure of the location of all shut-off valves; S1 was able to locate the electric panel. S1 was unsure how to operate the gas and water. Advisory was provided to ensure all staff know the location of each of the shut-off valves and know how to operate each one in case of emergency. Record Reviews: Review of 5 of 5 resident files was conducted, including but not limited to, review of Admission Agreement, Physician Reports, and Ambulatory Status. During this review, LPA did not observe PRN Authorization Letter for each of the residents. Also, LPA noted that the residents with restricted health conditions do not have restricted health care plan in place. Additional review is needed. Medication review was conducted for 1 resident at this time, including review of resident’s medication, PRN authorization letter, prescription records, Centrally Stored Medication Records, and Medication Administration Records. Additional review is needed. Review of 3 staff files included but not limited to background clearance, first aid/CPR certification, and training. Per review of Guardian and LIS, staff on duty during this visit (S2) was not associated at this facility. Per review of facility’s Personnel Report (LIC500) dated 5/18/2026, S2 has been working at this facility since May 15, 2026. During this visit, the AD associated S2 to this facility. LPA rechecked Guardian to confirm. Based on today's visit, this annual will require a continuation. A follow up visit will be conducted at a later date. Deficiencies observed during today's visit will be cited on the next visit. Exit interview was conducted and a copy of this report was provided.

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

On 6/16/2025, Licensing Program Analyst Arvin Villanueva (LPA) arrived at this facility unannounced to conduct their required annual inspection. LPA met with staff on duty, Luisa Saqusaqu (S5) and stated the purpose of this visit. The Administrator, Unaisi Waqalala, was notified and informed she was unable to be present during this inspection. Present during today's visit were 4 residents in care with 1 staff on duty (S1). Upon arrival LPA observed one resident at a dining table near the entrance of the facility. Another resident in the living room watching TV then eventually went to their bedroom. Per S1, residents just finished their lunch. One resident was observed in their bedroom listening to music with their headphones. Another resident was observed to be sitting in their bedroom, who then went to the bathroom during the physical inspection. LPA evaluated the physical plant with S5 to ensure the health and safety of the residents in care. The facility is a one-story home located in a residential neighborhood. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the inside of the facility to be clean and in good repair at this time. LPA inspected 5 of 5 resident bedrooms and were observed to be equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the hot water temperature in 1 of 2 resident bathroom to be 113 degrees Fahrenheit. Room temperature was observed at 82 degrees Fahrenheit upon arrival. LPA observed sufficient seven day non-perishable and two day perishable food supplies. One fire extinguisher was observed and were last inspected on 4/3/2025. Smoke and carbon monoxide detectors were observed and tested and found to be operable at this time. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. No bodies of water was observed at this time. Fireplace was observed to be screened and non-operational at this time. Exit doors have audible alarms. A medication box was observed inside the kitchen refrigerator and was found to be locked and not accessible to residents in care. Con't 809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Outdoor area was inspected. Facility has a covered porch equipped with outdoor furniture for resident use. Facility has 2 side gate exits. The right side of the facility (garage side), LPA observed the gate to be in disrepair as evidenced door stopper sticking out with nails exposed. The side fence has part of it with nails sticking out. Photos were sent to Administrator. Review of 5 resident files (R1, R2, R3 R4, R5) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. One resident (R5) did not have their Admission Agreement on file available for review during this visit. Review of 5 staff files (S1, S2, S3, S4, S5) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. It was noted that one staff (S4) was not associated to this facility. Record review of S4's training indicated that staff started on 11/15/2024. Additionally, it was discovered that S4's health screening was completed on 9/7/2023. Furthermore, review of S2's files revealed that S2 was associated to this facility on 5/30/25 and through interview with S3, S2 worked early in June 2025 to relieve S3. However, LPA discovered that S2's last health screen/TB test was completed on 6/19/2023. Administrator to submit current Liability Insurance Certificate, LIC500 and LIC308 to the Department. Based on today's visit, this annual will need continuation. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, following deficiencies were observed during today's visit: R5 did not have their Admission Agreement on file available for review. S2 did not have current Health Screening/TB test completed prior to working at this facility. S4 is not associated to this facility but per review of their training record indicated that their start date was on 11/15/24. Fence and side gate needs repair as evidence of nails sticking out. Citations will be issued when this annual is completed. The Department will return at a later date to complete the annual inspection. Exit interview was conducted and a copy of the report was provided upon exit.

Continues from LIC 9099 S1 stated R1's catheter was leaking and had to be sent to the hospital. S1 stated staff do not touch the catheter and only nursing staff does it. According to an interview with Staff 2 (S2), S2 remember R1. R1 was observed by S2 cutting R1's own catheter bag. S2 reported R1 would find random items to cut the bag. R1 would do this multiple times and be sent to the hospital each time. S2 reported the last time R1 was sent to the hospital, R1 never came back. According to an interview with Staff 3 (S3), S3 does not remember R1. LPA Valerio interviewed residents. LPA Valerio was unable to find information for R1 to conduct an interview. LPA Valerio interviewed Resident 2 (R2). R2 reported staff being great and had nothing to complain about here. R2 has not observed staff handling residents in a rough manner. According to an interview with Resident 3 (R3), R3 feels their needs are being met at the facility. R3 reported staff being gentle and kind. According to Administrator Unaisi, R1 went to the hospital and never returned to the care facility. The administrator reported she was unaware of where R1 moved and was not informed by the placement agency. Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was held with facility staff, and a copy of report was left at the facility with staff Ilaisa Niutabua.

This Department has investigated the allegation noted above and have found the complaint to be UNSUBSTANTIATED- A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted and a copy of report was left at the facility.