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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701485
Report Date: 07/29/2026
Date Signed: 07/29/2026 12:28:08 PM

Document Has Been Signed on 07/29/2026 12:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LOVING LEGACY SENIOR CAREFACILITY NUMBER:
342701485
ADMINISTRATOR/
DIRECTOR:		BANUVE, VENIANAFACILITY TYPE:
740
ADDRESS:8216 COTTON BALL WAYTELEPHONE:
(279) 229-7719
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 6CENSUS: 5DATE:
07/29/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Aisake (James) Jemesa and Anese WarfieldTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On July 29, 2026, at approximately 9:30am, Licensing Program Analyst, Arvin Villanueva (LPA), arrived at this facility unannounced to conduct a case management visit. LPA initially met with one of the staff on duty, Aisake (James) Jemesa, and stated the purpose of the visit. The administrator was notified by James. Per James the administrator is not coming today. This visit is being conducted concurrently with the complaint visit (complaint #27-AS-20260211151007)

Present upon arrival were 5 residents in care with 2 staff on duty. The assistant administrator, Anese Warfield was also present, along with an individual who was identified as Yelena Bigelow. Per Anese, she is being trained by Yelena and stated that Yelena just started today. Staff Aisake stated this is the first time he seen Yelena at this facility.

Upon LPA's arrival, Yelena was seen at the kitchen area, by the medication cabinet and residents' documents were accessible to Yelena. Yelena left the facility at around 9:35am.

During this visit, LPA reviewed Guardian at around 9:30am, Yelena’s name was not in the list that were associated to this facility. At around 10:03am, Anese showed from Guardian website that Yelena was associated with this facility on 7/27/2026. LPA rechecked Guardian and confirmed Yelana’s associated on 7/272026. However, there were inconsistencies with Yelena’s documents in Guardian. Yelena's documents were dated 7/29/2026 and LPA sent an email to Care Provider Management Bureau (Guardian) to verify the inconsistencies.

Also during this visit, LPA observed the fire door leading to bedrooms #1,2,3,4 was observed to be propped open with a door stopper throughout this visit (photo taken).

At this time, this case management will need continuation, pending verification from Guardian.

Base on today's visit, this facility is hereby cited per California Code of Regulations, Title 22, Division 6, Chapter 8.

Plan of correction and appeal process were discussed during the exit interview with Anese Warfield. A copy of this report and appeal rights were provided

Stephen Richardson
Arvin Villanueva
DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/29/2026 12:28 PM - It Cannot Be Edited


Created By: Arvin Villanueva On 07/29/2026 at 11:56 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LOVING LEGACY SENIOR CARE
FACILITY NUMBER: 342701485

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/30/2026
Section Cited
CCR
87203

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Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.
This requirement is not met as evidenced by:
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Corrected on site: after consulting with the assistant administrator, she removed the door stopper
Additional corrective action was discussed with the assistant admin.
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Based on observation, 1 of 2 fire doors was propped open with a a door stopper throughout this visit. This poses an immediate health, safety, and personal rights risks to persons in care.
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Per discussioin, they agreed to conduct in-service training with staff and residents to discuss fire safety, including the requirements relating to fire doors. Proof on training shall be submitted to the Department by 7/30/2026.

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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.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Arvin Villanueva
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2026


LIC809 (FAS) - (06/04)
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