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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701578
Report Date: 10/14/2025
Date Signed: 10/14/2025 03:46:29 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
08/22/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250822195248
FACILITY NAME:LOVING LEGACY SENIOR CARE IIFACILITY NUMBER:
342701578
ADMINISTRATOR:BANUVE, VENIANAFACILITY TYPE:
740
ADDRESS:6532 RANCHO GRANDE WAYTELEPHONE:
(279) 229-7719
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 6DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Facility Administrator: Veniana BanuveTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff mismanaged resident's medication
Staff did not safeguard resident's personal items
Staff handled resident in a rough manner
Staff does not assist resident with obtaining medical/dental care
INVESTIGATION FINDINGS:
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On 10/14/2025 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 Banuve 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. A brief interview with conducted with the administrator.

Allegation: Staff mismanaged residents medication
It was alleged that staff mismanaged residents medication. This investigation consisted of records reviewed, and interviews with residents. On 9/2/2025 LPA Hughes conducted a visit to the facility. LPA reviewed 3 out of 6 medications and the Medication Administration Record (MAR) was observed complete. Interviews with 5 out of 5 residents in care reflected no concerns with medication administration in the facility. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore unsubstantiated.

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

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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 5
Control Number 27-AS-20250822195248
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 II
FACILITY NUMBER: 342701578
VISIT DATE: 10/14/2025
NARRATIVE
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Allegation: Staff did not safeguard residents personal items

It was alleged that staff did not safeguard residents personal items. This investigation consisted of interview with the reporting party, interview with facility staff and interview with a resident in care. Interview with reporting party indicated that the allegation was no longer valid. Additional interview with facility staff stated that residents concerns about items missing in the facility are promptly addressed, facility staff stated that R1 concerns of missing items were not related to items being stolen in the facility. Interview with R1 revealed that they have no concern about items being stolen in the facility. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore unsubstantiated.

Allegation: Staff handled resident in a rough manner

It was alleged that staff handled resident in a rough manner . This investigation consisted of interview with facility staff and residents in care. On 10/7/2025 LPA Hughes conducted a visit to the facility and interviewed 1 facility staff and 4 out of 6 residents in care. Interview with facility staff (S1) indicated that staff deny allegations of handling a resident in a rough manner. Interview with 4 out of 6 residents indicated that residents have no concern about staff handling a resident in a rough manner. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore unsubstantiated.

Allegation: Staff does not assist resident with obtaining medical/dental care

It was alleged that staff does not assist residents with obtaining medical/dental care. This investigation consisted of interviews with facility staff, residents in care, and records review. On 10/7/2025 LPA Hughes conducted a visit to the facility and interviewed 1 facility staff and 4 out of 6 residents in care. Interview with facility staff (S2) reflected facility staff are responsible for scheduling appointments for residents, and transportation services. Records review of the facility Admission agreement states that the facility does provide fee-based transportation services for residents in care. This allegation could not be corroborated due to lack of evidence obtained. The allegation is therefore 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: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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
08/22/2025 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250822195248

FACILITY NAME:LOVING LEGACY SENIOR CARE IIFACILITY NUMBER:
342701578
ADMINISTRATOR:BANUVE, VENIANAFACILITY TYPE:
740
ADDRESS:6532 RANCHO GRANDE WAYTELEPHONE:
(279) 229-7719
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:6CENSUS: 6DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Facility Administrator: Veniana BanuveTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff do not meet resident's special dietary needs
INVESTIGATION FINDINGS:
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On 10/14/2025 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 Banuve 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. A brief interview with conducted with the administrator.

Allegation: Staff do not meet residents special dietary requirements
It was alleged that staff do not meet residents special dietary requirements. This investigation consisted of facility observation, interview with residents in care, and resident records review. On 9/02/2025 LPA Hughes conducted a visit to the facility and observed 5 residents sitting at the dining room table having breakfast and consuming food items that did not meet their prescribed dietary requirements. Interview with 3 out 6 residents revealed concerns with food being served in the facility. Additional review of facility’s Admissions Agreement indicates that residents in care will receive nutritious and well-balanced meals that meet their individual dietary meals requirements. This was observed not in compliance with Title 22 regulation 87555(a). Therefore the above allegation is substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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 5
Control Number 27-AS-20250822195248
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 II
FACILITY NUMBER: 342701578
VISIT DATE: 10/14/2025
NARRATIVE
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As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is 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 the facility administrator 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: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20250822195248
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 II
FACILITY NUMBER: 342701578
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2025
Section Cited
CCR
87555(a)
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87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Licensee will ensure the facility is in compliance with Title 22 regulation 87555. Licensee will ensure that all meals, including breakfast meet nutritional needs of all residents in care. Licensee agrees to create a menu that is consistent with the nutritional needs and dietary needs of all residents in care.
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This requirement was not met as evidenced by:
Licensee did not ensure that food being served in the facility was of good quality. LPA observed residents consuming breakfast items that were not considered healthy food choices.
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Licensee agrees to send proof of the facility menu and acknowledgment of the regulation by 10/17/2025 via email to LPA Hughes.
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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: 10/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5