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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701485
Report Date: 01/05/2026
Date Signed: 01/05/2026 12:13:41 PM

Substantiated


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
12/15/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251215084937
FACILITY NAME:LOVING LEGACY SENIOR CAREFACILITY NUMBER:
342701485
ADMINISTRATOR:BANUVE, VENIANAFACILITY TYPE:
740
ADDRESS:8216 COTTON BALL WAYTELEPHONE:
(279) 229-7719
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 6DATE:
01/05/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Facility Administrator: Veniana BanuveTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff are not ensuring that resident's diabetic needs are met.
Staff are not ensuring that skilled professionals are taking resident's blood pressure.
INVESTIGATION FINDINGS:
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On 01/05/2026 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 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.

Allegation: Staff are not ensuring that resident's diabetic needs are met
It was alleged that staff are not ensuring that residents diabetic needs are met. This investigation consisted of interviews with facility staff, reporting party, resident (R1) Home Health Nurse. On 12/17/2025 LPA Hughes conducted a visit to the facility and spoke with 2 out of 2 facility staff. Facility staff (S1) stated that they primarily ensure that (R1) diabetic needs are met. Stating that the facility are aware of R1’s diabetic needs and that the facility assists the resident in the facility with glucose monitoring and regularly observes the residents for changes in condition following the facilities protocol to assist the resident whenever their glucose levels are elevated.
Continuation 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
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 5
Control Number 27-AS-20251215084937
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: LOVING LEGACY SENIOR CARE
FACILITY NUMBER: 342701485
VISIT DATE: 01/05/2026
NARRATIVE
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 An interview with the reporting party reflected that the resident (R1) requires a higher level of care than what the facility can provide, however resident (R1) has denied the need for a higher level of care. The resident requires diabetic care, including injectable insulin administration, which exceeds the facilities scope of care. The facility does not employ licensed medical staff authorized to administer injectable medications. An interview with R1’s Home Health nurse confirmed that facility staff lack the skill and authorization to properly meet the resident’s diabetic needs. Resident (R1) has been hospitalized on multiple occasions due to complications related to diabetes management. Despite glucose monitoring by facility staff, the facility is unable to ensure care and supervision appropriate to the resident’s identified health care needs, as required by Title 22 regulation 87628(a), therefore the allegation is substantiated.

Allegation: Staff are not ensuring that skilled professionals are taking resident's blood pressure

It was alleged that Staff are not ensuring that skilled professionals are taking resident's blood pressure. This investigation consisted of interviews with facility staff, the reporting party, and resident (R1) Home Health nurse. On 12/17/2025 LPA Hughes conducted a visit to the facility and spoke with 2 facility staff. Facility staff (S1) stated that they are responsible for assisting resident (R1) with glucometer testing and reported having received additional training related to glucose monitoring. Despite training, staff remain unauthorized to administer injections. An interview with the reporting party indicated that (R1) requires a higher level of care than the facility can provide due to additional health concerns contributing to elevated glucose levels. An interview with resident (R1) Home Health nurse indicated that facility staff are unable to perform injectable medications and are limited in providing skilled medical care due to the facilities scope of care limitations. The Home Health nurse further stated that resident (R1) is legally blind and unable to self administer diabetic injections. Based on the investigation, the resident is legally blind and requires diabetic injections the facility does not employ licensed or trained medical professionals to administer injectable medications. This was observed not in compliance with Title 22 regulation Diabetes 87628(a). The citation was previously cited to the facility, Therefore, the citation will not be reissued at this time.

As a result, the allegations are 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 Veniana and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.


 
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
12/15/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251215084937

FACILITY NAME:LOVING LEGACY SENIOR CAREFACILITY NUMBER:
342701485
ADMINISTRATOR:BANUVE, VENIANAFACILITY TYPE:
740
ADDRESS:8216 COTTON BALL WAYTELEPHONE:
(279) 229-7719
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 6DATE:
01/05/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Facility Administrator: Veniana BanuveTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff are not ensuring that resident is provided with appropriate meals
INVESTIGATION FINDINGS:
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On 01/05/2026 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 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.

Allegation: Staff are not ensuring that resident is provided with appropriate meals
It was alleged that staff are not ensuring that resident is provided with appropriate meals. This investigation consisted of interviews with facility staff, residents, and resident (R1) Home Health nurse. On 12/17/2025 LPA conducted a visit to the facility and spoke with facility staff, and residents. Interview with facility staff indicated that all residents have different dietary requirements.

Continuation 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
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 5
Control Number 27-AS-20251215084937
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: LOVING LEGACY SENIOR CARE
FACILITY NUMBER: 342701485
VISIT DATE: 01/05/2026
NARRATIVE
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 Interview with facility staff (S1) and (S2) reported that residents have freshly prepared meals. Interview with residents 2 out of 2 residents in care stated that they have no concerns about meals being prepared and served in the facility. LPA attempted to speak with resident (R1) but was unable as the resident was hospitalized at the time of the visit. LPA spoke with (R1) Home Health nurse, who stated that they are unsure of meals provided to resident is a direct result of an increased concern for (R1) health needs. There is not enough 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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20251215084937
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: LOVING LEGACY SENIOR CARE
FACILITY NUMBER: 342701485
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/06/2026
Section Cited
CCR
87628(a)
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87628 Diabetes(a)The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing... and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional.
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The licensee agrees to remain in compliance with Title 22 regulation 87628 at all times. The licensee agrees to stop accepting and retaining residents whose medical care exceed the facilities scope of care. The licensee agrees to ensure all residents care needs which fall outside of the facilities scope of care...
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This requirement was not met as evidenced by:
The facility did not ensure that resident (R1) identified diabetic care needs were met through self-administration or by an appropriately skilled professional.
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are referred to appropriate services when necessary. The licensee review RCFE Prohibited Health Conditions and send LPA Hughes a statement of acknowledgement of review of the policy by 1/6/2025.
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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: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5