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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700919
Report Date: 03/23/2026
Date Signed: 03/23/2026 10:01:09 AM

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
12/31/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251231102322
FACILITY NAME:VITA BELLA ELDERLY CAREFACILITY NUMBER:
342700919
ADMINISTRATOR:ALITI N WAQALALAFACILITY TYPE:
740
ADDRESS:4082 73RD STREETTELEPHONE:
(916) 594-7250
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:10CENSUS: 10DATE:
03/23/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Aliti Waqalala TIME COMPLETED:
10:14 AM
ALLEGATION(S):
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Resident is being neglected by facility staff
Facility is not ensuring residents gets to doctors appointments
Facility does not ensure resident receives medications
INVESTIGATION FINDINGS:
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On 03/23/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility to conduct a complaint visit. LPA Lee met with Administrator Aliti Waqalala and explained the purpose of the visit. The purpose of the visit was to deliver the complaint finding regarding the above allegation. The facility’s current census is 10. A brief interview was conducted with Administrator Waqalala.

Based on interviews conducted with facility staff, as well as a review of records obtained during the investigation, it was learned that Resident 1 (R1) had multiple scheduled medical appointments that were not attended. R1 had an appointment on 06/25/2025 at 2:20 PM; however, according to the Administrator, Aliti, R1 was unable to attend due to transportation not arriving. The appointment was rescheduled to 07/02/2025 at 3:00 PM, but R1 again did not attend due to transportation issues, and the facility did not follow up to reschedule.

CONTINUED LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
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 6
Control Number 27-AS-20251231102322
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: 03/23/2026
NARRATIVE
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An additional appointment on 07/25/2025 was also missed due to transportation issues and a scheduling conflict with R1’s neurologist appointment; no follow-up or rescheduling was conducted by the facility. Furthermore, R1 had an appointment on 08/25/2025, which was missed due to a change in R1’s condition, and no attempt was made by the Administrator Aliti to reschedule. Confirmation from the clinic indicated that there were no completed encounters or rescheduled appointments for these missed visits. Moreover, a review of R1’s external referral form dated 06/19/2025 revealed that R1 had stopped following up with their neurology provider, and now that the office is closed a new referral will be submitted.

It was also learned that R1 was hospitalized on 11/06/2025 and discharged on 11/14/2025 with a change in condition, including a special diet of mechanical soft diet. A review of R1’s LIC 603A (Resident Appraisal) and LIC 625 (Needs and Services Plan) revealed that these documents were not updated to reflect R1’s change in condition. Additionally, it was learned that in the days leading up to hospitalization, R1 experienced a rapid and significant decline from baseline, including excessive mucus production resulting in choking episodes during sleep. Despite these symptoms, R1 was not promptly taken to the hospital or referred to a primary care provider, and this change in condition was not documented in facility records until addressed to Administrator Aliti on 01/05/2026. Per the Admission Agreement, the facility is responsible for regularly observing residents’ physical and mental conditions and arranging for incidental medical and dental care services; however, the facility did not meet these obligations.

On 01/06/2026, Licensing Program Analysts (LPAs) Lee and Tamayo reviewed medications for three of ten residents by comparing medications on hand with Medication Administration Records (MARs) and identified discrepancies. MARs were not initial on multiple days, making it unclear whether medications were administered as prescribed or if staff did not document administration. Additionally, medications were not consistently administered in accordance with bubble pack instructions regarding dates and times.
On 02/03/2026, LPAs Lee and Hughes reviewed Resident 2 (R2)’s MAR and observed missing initials for medication administration on 02/01/2026 and 02/02/2026. A review of R2’s medication, Amlodipine 10 mg (take one tablet by mouth daily), with a quantity of 30 tablets, and the Centrally Stored Medication Destruction Record (CSMDR), which indicated a start date of 11/05/2025, revealed discrepancies. Care staff Qadroka conducted a pill count and reported ten (10) tablets remaining, indicating inconsistencies in medication tracking. A review of R1’s MARs from October through January also showed discrepancies.

CONTINUED LIC 9099-C
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20251231102322
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/30/2026
Section Cited
CCR
87465(a)(1)
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87465(a)(1) Incidental Medical and Dental Care
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.

This requirement is not met as evidenced by:
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The Administrator agrees that all scheduled resident appointments are completed, and that any missed appointments are promptly rescheduled. The Administrator will also review the cited regulation and provide LPA Lee with a written statement acknowledging understanding of the regulation. (POC) is due by 03/30/2026 at 5:00 PM.
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Based on interview and record review, the licensee did not comply with the section cited above. Resident 1 (R1) had three scheduled medical appointments that were missed, and the facility did not attempt to reschedule any of them. This poses an immediate health, safety or personal rights risk to people 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: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20251231102322
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: 03/23/2026
NARRATIVE
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 MAR log for December 2025, shows some medications were documented as administered from 12/25/2025 to 12/27/2025 and some medications indicating that R1 did not get the medication since R1 was hospitalized during that time as well. Overall, the medication audit for R1 revealed multiple inconsistencies. Based on interviews, observations, and records reviewed during the investigation, LPA Lee was able to corroborate the allegations.

As a result, these allegations are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies were cited for two of the allegations: resident is being neglected by facility staff and facility does not ensure resident receives medications during a case management visit on 02/03/2026, therefore the findings are still substantiated and no citation for those two allegations will be given. However, the facility is being cited today for the allegation facility is not ensuring residents gets to doctors’ appointments. Citation is on LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Administrator, Aliti and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
12/31/2025 and conducted by Evaluator Pang Lee
COMPLAINT CONTROL NUMBER: 27-AS-20251231102322

FACILITY NAME:VITA BELLA ELDERLY CAREFACILITY NUMBER:
342700919
ADMINISTRATOR:ALITI N WAQALALAFACILITY TYPE:
740
ADDRESS:4082 73RD STREETTELEPHONE:
(916) 594-7250
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:10CENSUS: 10DATE:
03/23/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Aliti Waqalala TIME COMPLETED:
10:14 AM
ALLEGATION(S):
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Facility does not feed resident
INVESTIGATION FINDINGS:
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On 03/23/2026, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility to conduct a complaint visit. LPA Lee met with Administrator Aliti Waqalala and explained the purpose of the visit. The purpose of the visit was to deliver the complaint finding regarding the above allegation. The facility’s current census is 10. A brief interview was conducted with Administrator Waqalala.

It was alleged that the facility does not feed residents. This investigation included interviews with residents and facility staff, as well as observations. LPA Lee interviewed five (5) of the seven (7) residents, all of whom stated they are being fed by facility staff and reported no concerns. Two residents indicated that the facility had issues in the past related to insufficient food but stated that the issue has since been resolved. Resident 1 (R1) stated that they are being fed by facility staff.

CONTINUDED LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20251231102322
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: 03/23/2026
NARRATIVE
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 Moreover, Facility staff acknowledged that the facility did not always maintain the required two-day supply of perishable food and seven-day supply of non-perishable food; however, staff stated that residents were not being deprived of meals. In addition, the facility was cited on 01/06/2026 for insufficient food supplies.
During a prior facility visit on 01/05/2026, LPAs Lee and Tamayo toured the facility and observed seven (7) residents seated at the dining table eating breakfast. On 02/03/2026 facility visit, LPAs Lee and Hughes observed seven (7) residents eating breakfast, which included egg omelets, hash browns, toast, strawberries, blueberries, bananas, and coffee. Apples and oranges were also observed on the kitchen counter and available for resident access. Based on interviews and observations conducted during the investigation, LPA Lee was unable to corroborate the allegation.

The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.


An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6