<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701414
Report Date: 07/30/2026
Date Signed: 07/30/2026 11:57:08 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
02/11/2026 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260211150501
FACILITY NAME:LEGACY LANE SENIOR LIVINGFACILITY NUMBER:
342701414
ADMINISTRATOR:ISIKELI TUIKENATABUAFACILITY TYPE:
740
ADDRESS:7610 LA MANCHA WAYTELEPHONE:
(564) 200-1736
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:14CENSUS: 13DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Isikeli TuikenatabuaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
The facility allowed excluded individuals to work in the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/30/2026, Licensing Program Analyst (LPA) Pang Lee conducted an unannounced visit to the facility. LPA Lee met with Administrator Isikeli Tuikenatabua and explained the purpose of the visit. The purpose of the visit was to deliver the finding related to the allegation above. At the time of the visit, the facility census was 13.

It was alleged that the facility allowed excluded individuals to work at the facility. The investigation consisted of interviews with facility staff and the Administrator, facility residents, and other relevant individual, as well as observation. During an interview, Administrator Isikeli Tuikenatabua acknowledged that Excluded Individual 1 (E1) had been present at the facility approximately August or September 2025. The Administrator stated that, as a newly appointed Administrator, they were unaware that E1 and E2 were excluded individuals and admitted that E1 would come to the facility to provide assistance when Administrator contacted E1.
CONTINUED LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
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 5
Control Number 27-AS-20260211150501
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: LEGACY LANE SENIOR LIVING
FACILITY NUMBER: 342701414
VISIT DATE: 07/30/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The Administrator further acknowledged that E2 was present at the facility in December 2025 during a Community Care Licensing Division (CCLD) visit. Two additional staff, S1 and S2 also acknowledged that E1 and E2 were in the facility in December of 2025 as well. Five of the nine residents interviewed reported seeing both E1 and E2 at the facility. Additionally, during a separate case management visit on 12/04/2025, Licensing Program Analyst (LPA) Avelina Martinez observed E2 present at the facility. Based on interviews conducted during the investigation. LPA Lee was able to corroborate the allegation that excluded individuals were present in the facility. This was observed not in compliance with Title 22 regulation 87777(a) Exclusions as the facility did not ensure an excluded individuals were not permitted to be present in the facility.

As a result, this allegation is SUBSTANTIATED. The finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Administrator Tuikenatabua and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility. An immediate civil penalty of $500 was assessed during today's visit.
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260211150501
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: LEGACY LANE SENIOR LIVING
FACILITY NUMBER: 342701414
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/30/2026
Section Cited
CCR
87777(a)
1
2
3
4
5
6
7
87777(a) Exclusions
The Department may prohibit an individual from serving as a board of directors, executive director, or officer; being employed or allowed in a licensed facility as specified in Health and Safety Code Sections 1569.58 and 1569.59.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Effective immediately, all excluded individuals are prohibited from entering or being present at the licensed facility. The Administrator stated that they will ensure no excluded individual is permitted to work, provide services, visit, or otherwise be present at the facility or have any contact with residents or staff.
8
9
10
11
12
13
14
The facility did not ensure excluded individuals (E1) and (E2) were prohibited from being at a licensed facility. (E1) and (E2) were observed at the facility on multiple occasions.
8
9
10
11
12
13
14
The Administrator will submit a written plan to CCLD outlining the procedures that will be implemented to ensure excluded individuals are not allowed to work, provide services, interact with residents or staff, or enter the facility in the future. An immediate civil penalty in the amount of $500 was assessed during today's visit.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 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
02/11/2026 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260211150501

FACILITY NAME:LEGACY LANE SENIOR LIVINGFACILITY NUMBER:
342701414
ADMINISTRATOR:ISIKELI TUIKENATABUAFACILITY TYPE:
740
ADDRESS:7610 LA MANCHA WAYTELEPHONE:
(564) 200-1736
CITY:SACRAMENTOSTATE:CAZIP CODE:
95823
CAPACITY:14CENSUS: 13DATE:
07/30/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Isikeli TuikenatabuaTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are forging resident documents.
The Administrator is not present at the facility for a sufficient amount of time.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/30/2026, Licensing Program Analyst (LPA) Pang Lee conducted an unannounced visit to the facility. LPA Lee met with Administrator Isikeli Tuikenatabua and explained the purpose of the visit. The purpose of the visit was to deliver the findings related to the allegations above. At the time of the visit, the facility census was 6.

It was alleged that staff were forging resident documents. The investigation included interviews with facility staff, residents, as well as a review of records. During interviews, with three out of three facility staff members (S1 and S2) denied forging any resident documents. S1 and S2 shared that Administrator Isikeli Tuikenatabua obtains the residents LIC 602 Physician’s report and wouldn’t know if residents’ documents are forged. Administrator Tuikenatabua also denied the allegation and that residents LIC 602 Physician’s Report are forged.

CONTINUED LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20260211150501
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: LEGACY LANE SENIOR LIVING
FACILITY NUMBER: 342701414
VISIT DATE: 07/30/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Per Administrator Tuikenatabua they take the residents LIC 602 Physician’s report with the residents to the resident’s primary care provider to have the report complete and filed out and that depending on the PCP it is either completed during the visit, or it can be faxed over to the facility. In interviews with nine out of nine residents in care, all who stated that either the facility, family members or themselves take them to the clinic for their appointments and that the facility calls EMS if needed. On 02/17/2026, LPA Lee conducted a visit to the facility and collected LIC 602 Physician’s Reports for eleven residents. Based on the records reviewed, all Physician’s Reports contained physician signatures and were filled out and complete. On 03/18/2026, LPA Lee contacted the Licensed Medical Professionals who had completed the residents’ LIC 602 Physician’s Reports; however, they were unable to provide information or verify whether the records were forged or falsified. Based on the information obtained, there is insufficient evidence to substantiate the allegation that the facility is forging resident documents.

It was alleged that the Administrator is not present at the facility for a sufficient amount of time. This investigation consisted of interviews with facility staff, residents, a review of facility records, and observations. Based on interviews, three of three staff members denied the allegation. Staff S1 and S2 stated that the Administrator is Isikeli Tuikenatabua, who also goes by the nickname "Twoey" to make it easier for residents to pronounce the name. Both staff reported that the Administrator is at the facility "every day" and "all the time," generally from 7:00 a.m. to 7:00 p.m., and expressed no concerns regarding the allegation. The Administrator denied the allegation and stated that their work schedule is consistent with the facility's LIC 500, Personnel Report. Additionally, interviews with nine of nine residents identified "Twoey" as the person in charge of the facility and stated that they’re at the facility “everyday.” A review of the facility’s LIC 500 Personnel Report states that the Administrator is scheduled to work Monday through Friday from 7:00 a.m. to 7:00 p.m. The Department has conducted eight visits to the facility, and during those visits, the Administrator was present seven out of eight facility visits. Based on interviews, records reviewed, and the Department's observations, there is insufficient evidence to support the allegation that the Facility Administrator is not present at the facility for a sufficient amount of time.

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: Arielle Pascua
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5