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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701013
Report Date: 10/23/2025
Date Signed: 10/23/2025 03:31:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251015132407
FACILITY NAME:ABUNDANT PEACEFACILITY NUMBER:
342701013
ADMINISTRATOR:BARBARA HALL WILLIAMSFACILITY TYPE:
740
ADDRESS:19 SYNTHIA COURTTELEPHONE:
(916) 856-6464
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 6DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Atelaite Peti and Vereas Taqasi TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff left resident in soiled clothing for an extended period of time
INVESTIGATION FINDINGS:
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On 10/23/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care staff Atelaite Peti and explained the purpose of the visit. LPA Lee was later met by Assistant Administrator Vereas Taqasi. The purpose of this visit is to deliver complaint finding for the allegation above. A brief interview conducted with care staff Peti. and Assistant Administrator Taqasi. The current census is six residents with one staff.

It was alleged that facility staff left resident in soiled clothing for an extended period of time. The investigation included observations and interviews with staff, residents, the resident’s responsible party, and four outside agencies. Based on LPA Lee’s observations during facility visits on 08/05/2025, 09/22/2025, 10/14/2025, 10/21/2025, and during today’s visit no malodorous or incontinent odors were observed in the facility. LPA Lee interviewed three facility staff members who denied the allegation and stated that only resident 1 uses incontinence briefs and the rest of the resident doesn't wear incontience briefts. Interviews were also conducted with two family members of a resident, who confirmed the allegations.
CONTINUED LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 27-AS-20251015132407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ABUNDANT PEACE
FACILITY NUMBER: 342701013
VISIT DATE: 10/23/2025
NARRATIVE
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However, interviews with six out of six residents stated that staff are assisting residents with incontinence care and that they have no concerns regarding residents being left in soiled clothing. Additionally, three out of four outside agency representatives interviewed reported that they have not observed or detected any incontinence related odors during their visits to the facility. Based on observations and interviews statement conducted during the investigation process LPA Lee was unable to corroborate the allegation.

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 violation(s)occurred. An exit interview was conducted with care staff Peti, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251015132407

FACILITY NAME:ABUNDANT PEACEFACILITY NUMBER:
342701013
ADMINISTRATOR:BARBARA HALL WILLIAMSFACILITY TYPE:
740
ADDRESS:19 SYNTHIA COURTTELEPHONE:
(916) 856-6464
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 6DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
01:11 PM
MET WITH:Atelaite Peti and Vereas Taqasi.TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Administrator does not spend sufficient number of hours at the facility.
INVESTIGATION FINDINGS:
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On 10/23/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with care staff Atelaite Peti and explained the purpose of the visit. LPA Lee was later met by Assistant Administrator Vereas Taqasi. The purpose of this visit is to deliver complaint finding for the allegation above. A brief interview conducted with care staff Peti. and Assistant Administrator Taqasi. The current census is six residents with one staff.

It was alleged that the Administrator does not spend a sufficient number of hours at the facility. The investigation included observations and interviews with facility staff, residents in care and residents responsible party, and outside agencies. During multiple unannounced visits conducted on 09/22/2025, 10/14/2025, 10/21/2025, and today’s visit, LPA Lee did not observe an Administrator present at the facility. Interviews with four facility staff members stated that they did not know who the facility Administrator was. Two care staff members indicated that their work schedules were arranged by another individual responsible for scheduling, not by the Administrator.
CONTINUED LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20251015132407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ABUNDANT PEACE
FACILITY NUMBER: 342701013
VISIT DATE: 10/23/2025
NARRATIVE
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 On 10/21/2025, LPA Lee met with an individual who identified himself as the Assistant Administrator, Veresa Taqaso which LPA Lee was not made aware that the facility had an Assistant Administrator nor have LPA Lee met the individual. Assistant Administrator Taqaso stated that he believed staff #1 (S1) was the facility’s Administrator; however, LPA Lee confirmed that S1 is not associated with the facility as the designated Administrator. Former Administrator Barbara Williams reported that she has not been to the facility since late July and was informed by the Licensee Murphy Grant that he would handle the responsibility for administrative duties. She also confirmed that she resigned as Administrator as of 10/16/2025.
Moreover, LPA Lee was not aware that Former Administrator Williams had stopped performing administrator duties and responsibilities. Interviews with two family members of residents corroborated that, following LPA Lee’s visit on 08/05/2025, Administrator Williams has not been present at the facility. They noted that various staff have been coming to the facility since that time and are not sure who are the main caregivers to the facility. Six out of six residents interviewed stated that Administrator Williams has not been seen at the facility since late July and that different staff have been appearing on-site. Residents and family members expressed confusion and concerns about who the caregivers and management staff. Two outside agencies also confirmed that they have not met or communicated with an Administrator at the facility and have only interacted with care giving staff.

During a telephone call with Licensee Grant on 09/22/2025, he stated that Administrator Barbara Williams would continue to serve as the facility’s administrator until a new administrator was hired. However, it was learned that Administrator Williams had not been present at the facility since LPA Lee’s visit on 08/05/2025. According to the facility’s LIC 500 Personnel Report dated 08/27/2025, Barbara Williams was listed as the designated administrator. The LIC 500 however, did not specify the days and hours that administrator Williams would be present at the facility. During LPA Lee’s visit on 10/21/2025, a newly posted LIC 500 dated 10/20/2025, was observed at the facility. This updated report listed Filipe Naikaso as the designated administrator, with the following schedule: Saturday from 9:00 a.m. to 5:00 p.m., Sunday from 9:00 a.m. to 5:00 p.m., and Monday from 5:00 p.m. to 9:00 p.m. On 10/02/2025, Licensee Grant emailed LPA Lee requesting to change the designated administrator and associate Naikaso in the role as the new administrator to the facility. However, on October 13, 2025, LPA Lee sent a follow-up email to Licensee Grant indicating that Filipe could not be associated as the new administrator until documentation of Filipe’s education or equivalent qualifications was received.

CONTINUED LIC 9099-C
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20251015132407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ABUNDANT PEACE
FACILITY NUMBER: 342701013
VISIT DATE: 10/23/2025
NARRATIVE
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 As of today, LPA Lee has not received the required documentation verifying Filipe’s education or equivalent qualifications. Based on observation, records review and interviews statement conducted during the investigation process LPA Lee was able to corroborate the allegation.

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 standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with care staff Peti and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20251015132407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ABUNDANT PEACE
FACILITY NUMBER: 342701013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2025
Section Cited
CCR
87405(a)
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87405(a) 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…


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Licensee/facility agrees to appoint/assign an Administrator by 10/27/2025. Implement a temporary point of contact/Admin by10/24/2025. Admin documents and Temporary admin information should
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This was not met as evidence by:
Based on interviews, observation and visits to the facility, the Administrator has not at facility. It was learned that administrator Barbara Williams has not been present at the facility since LPA Lee’s visit on 08/05/2025 and is not carrying out administrator duties. This posed a potential health and safety risk to residents.
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be emailed to LPA Lee by 10/24/2025 by 5:00 PM. A statement of reviewing and understanding the regulation cited will also be provided to LPA Lee by POC due date 10/27/2025 end of day.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6