342700919-10-17-2025-27-AS-CACL-DNE337-20251113165303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700919
Report Date: 10/17/2025
Date Signed: 10/17/2025 09:41:39 AM

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
10/02/2025 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20251002101620

FACILITY NAME:	VITA BELLA ELDERLY CARE		FACILITY NUMBER:	342700919
ADMINISTRATOR:	ALITI N WAQALALA		FACILITY TYPE:	740
ADDRESS:	4082 73RD STREET		TELEPHONE:	(916) 594-7250
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95820
CAPACITY:	10	CENSUS: 10	DATE:	10/17/2025
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Aliti Waqalala		TIME COMPLETED:	09:48 AM

ALLEGATION(S):

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staff did not assist resident in care

INVESTIGATION FINDINGS:

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On 10/17/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Administrator Aliti Waqalala and explained the purpose of the visit. The purpose of this visit is to deliver complaint finding for the allegation above. The current census is 10 with 2 facility staff. A brief interview conducted with Administrator Waqalala.

It was alleged that staff did not assist residents in care. An investigation was conducted, which included a review of records as well as interviews with staff and residents. It was learned that on 09/27/2025, Resident 1 (R1) was seated on the sofa and attempted to stand. Resident 2 (R2) initially attempted to assist R1, then walked away to inform Staff 1 (S1). At the time, S1 was in the kitchen preparing dinner and needed to turn off the stove before attending to R1. In interviews, both R1 and R2 confirmed that S1 did provide assistance.

CONTINUED LIC

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20251002101620

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: VITA BELLA ELDERLY CARE	FACILITY NUMBER: 342700919
	VISIT DATE: 10/17/2025

NARRATIVE

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Resident 3 (R3), who observed the situation, stated they were unsure whether staff assisted the situation, as they returned to their room before the interaction was complete. LPA Lee interviewed 6 of 6 residents, all of whom reported that facility staff are responsive and provide assistance when needed. 6 out of 6 residents also stated having seen staff assist R1 with standing and transfer in the past. Three staff members were also interviewed. All denied having witnessed any instances where staff did not assist residents with care. It was also learned during the investigation that R2 is protective of R1 and often attempts to assist R1 directly. Staff have previously redirected R2 to notify staff instead. Based on the interview statements 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.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

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