Abounding Peace Iii Elderly Care.

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.

On 7/7/23, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a quarterly health and safety visit following the Informal Conference conducted on 6/19/2023. Upon LPAs arrival, facility staff Alica Reid and Eliki Seruvatu were present at facility. LPA requested that Alicia go ahead and contact the facility designated Administrator, Unaisi Waqalala, to inform her that CCL was present at this time. LPA Truong was advised that staff Alicia can assist LPA with today’s inspection and sign the report. LPA toured and inspected the physical plant inside and outside to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in sanitary condition. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water measured at 114.8 degrees Fahrenheit. The temperature inside was observed at 69 degrees Fahrenheit. Fire extinguisher and first aid kit was up to date. LPA reviewed (2) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. Based on a review of this facility during today’s visit, it was determined that this facility was found to be in compliance at this time. No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conducted and a copy of this report was left at the facility.

Licensing Program Analyst (LPA) Pang Lee arrived at the facility on 06/09/2023 at 11:34 AM to conduct an unannounced Plan of Correction (POC) visit. LPA met with Alicia Reid. LPA explained the purpose of the visit. The purpose of this visit is to follow-up on a plan of correction that were due 06/26/2023. During today's visit, LPA Lee toured and inspected the facility to ensure deficiency previously cited on 06/12/2023 have been corrected. 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 and associated to the facility. Based upon this inspection, LPA Lee observed the following: 1. Deficiency cited under Title 22 Regulation 87411(g)(2) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee. 2. Deficiency cited under Title 22 Regulation 87303(a) has been cleared. Licensee complied with the terms of the POC by POC due date. Proof of correction was submitted by email on 06/26/2023. Licensee complied with the terms of the POC by POC due date. Facility was provided with POC cleared letter. Exit interview conducted and a copy of this report provided.

A virtual Informal conference was conducted today on 06/19/2023 at 9:00 AM via Microsoft Teams. The purpose of the meeting is to discuss complaint allegations and non-compliance concerns. Present in the meeting are Licensing Program Manager Czarrina Camilon-Lee, and Licensing Program Analyst Pang Lee, Licensee Unaisi Waqalala. The informal conference process was explained during this meeting to include the administrative process. Discussed Concerns: The following concerns were discussed: Recent allegation, staff fingerprint clearances, staff associations, staff elopement, staff files, mandated reporting and Technical Support Program (TSP). The facility has stated they will do the following to achieve continued and substantial compliance: · Ensure hired staffs are fingerprint cleared and trained before staff starts working at the facility. · Ensure all staff are compliant with all required training's. · Conduct training for all staff and ensure all staff knows where staff and residents file are kept in the facility. · Ensure all staff and resident files are current and complete. · Ensure and train all staff to be comfortable and not get nervous when CCL visits · Ensure two current staff completes their administrator training and are associated to all facilities · Ensure all staffs are associated to facility Abounding Peace Elderly Care 342700827, Abounding Peace Elderly Care II 342701091 and Abounding Peace III Elderly Care 342701174 staff not associated to other facilities when coverage is needed. Continued LIC-809 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 · Licensee agrees to dedicate self to Abounding Peace III Elderly Care 342701174 once she has current and qualified administrator for both Abounding Peace Elderly Care 342700827 and Abounding Peace Elderly Care II 342701091 and then licensee will hire a qualified administrator for Abounding Peace III Elderly Care 342701174. · Facility Administrator will ensure compliance plan is being followed at all times. · Submit LIC 500 Personnel document and LIC 308 Designated Responsibility document to Community Care Licensing Department (CCLD) by June 26, 2023 by 5:00 PM. Licensee Unaisi Waqalala reported all facility plans to achieve compliance will be submitted to the Community Care Licensing Department by June 26, 2023, by 5:00 PM. Continued... Community Care Licensing Department (CCLD) will do the following : · Increase Monitoring · Technical Support Program (TSP) referral The licensee was advised failure to follow agreed plan could result in a Non-Compliance Conference. No deficiencies were cited during today's meeting. An exit interview was conducted with facility representatives Unaisi Waqalal , and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.