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32 | Four of the four residents interviewed stated they had not observed the excluded individuals at the facility. Two additional residents declined to be interviewed. LPA Lee reviewed the facility's LIC 500, Personnel Report, and the Guardian background check system and found that neither excluded individual was listed as facility personnel. Additionally, since the change of ownership on 07/07/2025, the Department has conducted six visits to the facility, during which LPA Lee did not observe either excluded individual on-site. Based on interviews, record reviews, and observations, there is insufficient evidence to support the allegation that the facility allowed excluded individuals to work at the facility. Therefore, the allegation is unsubstantiated.
It was alleged that staff were forging resident documents. The investigation included interviews with facility staff and residents, as well as a review of facility records. During interviews, S1 and Administrator Kaloulasulasu denied the allegation, stating that the residents' LIC 602 Physician's Reports were obtained during the change of ownership and that no documents had been altered or falsified. Four of the four residents interviewed stated that facility staff transport them to medical appointments or the hospital when needed. During a facility visit on 02/17/2026, LPA Lee collected residents LIC 602 Physician's Reports for six residents. A review of the records showed that all six reports were complete and contained physician signatures. On 03/18/2026, LPA Lee contacted the licensed medical professionals who completed the six residents' LIC 602 Physician's Reports; however, they were unable to verify whether the documents had been forged or falsified. LPA Lee also attempted to verify the authenticity of the physician signatures but was unable to confirm. Based on interviews and the records reviewed, there is insufficient evidence to support the allegation that the facility forged resident documents. Therefore, the allegation is unsubstantiated.
It was alleged that the facility Administrator is not present at the facility for a sufficient amount of time. The investigation consisted of interviews with facility staff and residents, as well as a review of facility records and observations. S1 denied the allegation, stating that Administrator Kaloulasulasu oversees two facilities and divides his time between them. S1 reported that when the Administrator is not on-site, he remains available by phone and that S1 has no concern regarding the Administrator's availability. S1 further stated that Administrator Kaloulasulasu is present at the facility approximately two to three times per week.
CONTINUED LIC 9099-C |