342700919-7-15-2026-27-AS-APAA-DWQPP4-20260807112854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700919
Report Date: 07/15/2026
Date Signed: 07/15/2026 10:24:40 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
02/11/2026 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20260211122958

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:	07/15/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sera Nakalevu		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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1) The facility allowed excluded individuals to work in the facility.
2) Staff are forging resident documents.
3) The Administrator is not present at the facility for a sufficient amount of

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection at Vita Bella Elderly Care (RCFE) on DATE at TIME to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with staff, Sera Nakalevu and together discussed the investigation details.

Based on files obtained and reviewed during the investigation process, LPA Gould was unable to corroborate the allegation. LPA reviewed 10 resident files. LPA requested and obtained the admission agreement and physician reports (LIC 602) for all 10 residents in care (see confidential name list LIC-811 dated 7/15/26). LPA Gould reviewed reports for each resident. Upon review, the department has no concerns the physician reports are being altered or fraudulent. All 10 files reviewed appear to be completed by the resident’s physician or an appropriately skilled professional that are able to complete the forms per department regulations.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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-20260211122958

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: 07/15/2026

NARRATIVE

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Additionally, LPA conducted interviews with four staff members and four residents. All staff interviewed denied excluded individuals presence at the facility and had knowledge they are not allowed at any licensed facility. The four residents interviewed denied witnessing any individuals identified in the complaint as being present at the facility or did not recognize photos of the identified individuals.

All staff interviewed knows who the administrator is and identified her most recent date working as the previous weekend. Administrator is currently identified as sick this week. All four residents interviewed were able to identify who the facility administrator is and identified her most recent working date as the previous weekend. All residents interviewed identified the administrator present on a regular basis.

Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Other are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies cited per California Code of Regulations, TITLE 22.

Exit interview was conducted with facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

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