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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701091
Report Date: 07/15/2026
Date Signed: 07/15/2026 02:59:53 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
02/11/2026 and conducted by Evaluator Kevin Gould
COMPLAINT CONTROL NUMBER: 27-AS-20260211141320
FACILITY NAME:ABOUNDING PEACE ELDERLY CARE IIFACILITY NUMBER:
342701091
ADMINISTRATOR:UNA WAQALALAFACILITY TYPE:
740
ADDRESS:5490 ENRICO BLVDTELEPHONE:
(916) 898-1793
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY:15CENSUS: 14DATE:
07/15/2026
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Adi LinaTIME COMPLETED:
03:30 PM
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 time.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Kevin Gould made an unannounced inspection at Abounding Peace Elderly Care II (RCFE) on 7/15/26 at 1:40pm to conclude the investigation of the above allegation and to deliver the findings. LPA Gould met with staff, Adi Lina 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 14 resident files. LPA requested and obtained physician reports (LIC 602) for all 14 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 for 11 of the 14 physician reports are being altered or fraudulent. The 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
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)
Page: 1 of 2
Control Number 27-AS-20260211141320
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: ABOUNDING PEACE ELDERLY CARE II
FACILITY NUMBER: 342701091
VISIT DATE: 07/15/2026
NARRATIVE
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Additionally, LPA conducted interviews with five staff members and five residents. All staff interviewed denied excluded individuals presence at the facility. Some staff members interviewed had no knowledge of the individuals. The five residents interviewed and due to cognitive impairments were unable to provide any substantive information related to the allegation.

four of the five staff interviewed knew who the administrator is and identified her most recent date. LPA attempted interviews with five residents who were unable to provide substantive information due to cognitive impairments. Based on LPAs history with the facility and history of inspections, LPA has determined the facility administrator or their designee were present at approximately 80 percent of inspections within the last 12 months.

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)
Page: 2 of 2