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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701485
Report Date: 01/15/2026
Date Signed: 01/15/2026 12:01:56 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
01/14/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260114152118
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: 5DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Facility Staff: Aisake JemesaTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff illegally evicted a resident in care.
INVESTIGATION FINDINGS:
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On 01/15/2026 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. A brief interview with conducted with Aisake.

Allegation: Staff illegally evicted a resident in care.
It was alleged that staff illegally evicted a resident in care. This investigation consisted of interviews with staff, and records reviewed. On 01/15/2026 LPA Hughes conducted a visit to the facility. LPA interviewed 2 out of 3 facility staff, who stated that resident (R1) was hospitalized and that the facility refused (R1) readmittance to the facility due to R1’s ongoing health care needs, which staff stated exceeded the facilities scope of care. Interview with facility staff (S1) stated that a written eviction notice was not issued to (R1) prior to refusing readmittance.

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

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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-20260114152118
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: 01/15/2026
NARRATIVE
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Additional interview with facility staff (S2) stated that an eviction notice was requested from the admitting hospital care coordination team, but the facility was unable to provide the eviction notice issued by the licensee. LPA reviewed facility reports submitted to the Dept, however no written eviction notice for resident (R1) was received or on file with the Dept. This allegation was observed not in compliance with Title 22 regulation 87224(a) Eviction Procedures as the licensee did not ensure a written lawful eviction notice was provided to the resident.

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 appeal rights were provided to facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 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
01/14/2026 and conducted by Evaluator Shakaricka Hughes
COMPLAINT CONTROL NUMBER: 27-AS-20260114152118

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: 5DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Facility Staff: Aisake JemesaTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not follow resident's dietary plan.
INVESTIGATION FINDINGS:
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On 01/15/2026 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 allegations above. The current census is 5. A brief interview with conducted with Aisake.

Allegation: Staff did not follow resident's dietary plan.
It was alleged that staff did not follow resident’s dietary plan. This investigation consisted of interviews with facility staff and interview with R1’s Home Health nurse and records review. On 01/15/2026 LPA Hughes conducted a visit to the facility. LPA interviewed 2 out of 3 facility staff, who stated that the facility has followed R1’s dietary plan, outlining the diabetic nutritional needs of resident (R1). Interview with facility staff (S2) stated that the resident has consistently been hospitalized despite the facility attempts to follow protocol and provide dietary requirements to meet the needs of the resident.

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

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260114152118
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: 01/15/2026
NARRATIVE
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 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 that meals provided to resident in the facility is a direct result of an increased concern for R1’s on-going health needs. LPA reviewed R1’s discharge summary for resident (R1) dated 12/08/2025, which indicated that the resident’s diagnosis, however no dietary orders were indicated. 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 allegation 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 occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20260114152118
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: 01/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/15/2026
Section Cited
CCR
87224(a)
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87224 Eviction Procedures(a)The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)
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Licensee will ensure the facility is in compliance with Title 22 regulation 87224 at all times. Additionally, licensee agrees that all evictions will be issued through a timely written lawful eviction notice in accordance with Title 22 Eviction Procedures.
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This requirement was not met as evidenced by:
The facility refused resident (R1) readmittance following hospitalization without issuing a written eviction as required by Title 22 regulation. This posed a potential health, safety, and resident rights risk to residents in care.
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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: 01/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5