347004197-2-26-2025-27-AS-KHOS-DEVR4W-20250318124214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347004197
Report Date: 02/07/2025
Date Signed: 02/26/2025 09:26:32 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
07/16/2024 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240716162206

FACILITY NAME:	OHANA HOSPITALITY		FACILITY NUMBER:	347004197
ADMINISTRATOR:	AGNES SUMAGIT		FACILITY TYPE:	740
ADDRESS:	5117 HEATHER RANCH WAY		TELEPHONE:	(916) 534-7707
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95742
CAPACITY:	0	CENSUS: 0	DATE:	02/07/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Agnes Sumagit		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident in care was financially abused by a facility staff person
Resident was illegally evicted from their home

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Vincent Moleski and Kimberly Viarella and Licensing Program Manager (LPM) Stephen Richardson met with former licensee Agnes Sumagit virtually via Microsoft Teams to deliver findings on this complaint investigation. LPA Moleski explained the purpose of the meeting.

This investigation consisted of interviews, observation, and record review.

Regarding the allegation of financial abuse:

In an interview with LPA Moleski on 7/16/24, a former resident of this facility (R1) disclosed that administrator Renilyn Campos (S4) had used their bank card and had access to their financial accounts. R1 said that at first, they voluntarily gave S4 access to their finances, but later discovered that S4 was stealing from them.

[continued on 9099-C]

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

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 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

NARRATIVE

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R1 was admitted to Ohana Hospitality on 6/16/23, according to their admission agreement. R1 was relocated from this facility some time in July 2024, and was moved to another licensed Residential Care Facility for the Elderly (RCFE) owned and operated by S4. During LPA Moleski’s visit to S4’s facility on 7/16/24, LPA Moleski seized R1’s files in order to begin an investigation into R1’s allegations of financial abuse pursuant to 22 CCR Section 87755(c). LPA Moleski asked S4 to provide all documents pertaining to R1. S4 produced a binder with licensing forms and other care-related documentation. LPA Moleski returned to S4’s facility on 7/18/24 to return this binder and found a notebook in plain view labeled “Ohana Hospitality Ongoing Notes [R1]” which was not provided to LPA Moleski initially. This notebook contained various handwritten notes regarding R1’s finances. The first entry into the notebook was dated 6/17/23, and appeared to authorize S4 to conduct financial transactions on R1’s behalf and to pay in advance for services rendered. A signature, written in differing handwriting from the main body of the note, was illegible. A note dated 11/14/23 appeared to authorize S4 to withdraw $10,000 from R1’s account to pay a friend. Initials and the name of the friend were written in different handwriting beneath the note. S4’s business account bank records show that the account received a payment of $10,000 on 11/15/23. A note dated 11/17/23 reads: “7,000.00 – part payment for Nov. 2023. 4800 –.” The note was unsigned. On 11/20/23, S4’s business account received a payment of $7,000. A note dated 12/9/23 stated that R1 donated $5,000 to staff and residents for Christmas. Illegible initials appear below the note. On 12/11/23, S4’s business account received a payment of $5,000. A note dated 12/15/23 appeared to authorize S4 to withdraw $10,000 from R1’s account to pay in advance for basic services rendered at Ohana Hospitality. Illegible initials appear below the note. On 12/18/23, a $10,000 charge was made to S4’s business account, according to R1’s bank records. More than $47,000 was charged to S4’s business accounts in the month of December 2023 alone. In an interview, S4 said that R1 occasionally made advance payments for rent.

Ohana Hospitality submitted an affidavit on 7/1/08 affirming under penalty of perjury that staff would not handle any cash resources for any residents of the facility. The affidavit was signed by Sumagit. In an interview, S4 repeatedly denied handling resident cash resources, but acknowledged that R1 had given their bank card in order to make transactions on behalf of R1. S4 said that R1 was very generous, and asked S4 to purchase items for the facility.

[continued on 9099-C]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 8 of 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

NARRATIVE

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Community Care Licensing Division (CCLD) auditors reviewed R1's bank records and other financial documents and observed that R1’s account was charged a total of $143,981 to a company owned by S4, which was licensee of S4’s own facility, during a 13 month period between June 2023 and July 2024. In an interview, S4 said these charges were made via Square to charge for R1’s rent. R1 also paid a $600 check to S4 on 2/14/24 which indicated it was for rent, for a total of $144,581 paid to S4 during this 13 month period. According to R1’s admission agreement, their base rent, including all care costs and supplemental services, cost $4,800 per month, which means R1 should have been charged $62,400 during this same time period. After deducting $6,620, which was deposited to R1 from S4’s company, R1 was overcharged a total amount of $75,561 over the course of 13 months.

R1's bank account also listed a number of suspicious ATM withdrawals throughout the Sacramento Area, totaling $27,504.50. S4’s bank statements showed that cash deposits were made either on the same date or shortly after cash withdrawals were made from R1’s account. R1 was non-ambulatory, according to R1’s medical assessment dated 6/9/23. Three withdrawals were made at an ATM at a casino on 1/22/24, another withdrawal at the same casino’s ATM was made on 2/6/24, and a third withdrawal was made at a different casino on 2/28/24. In an interview on 7/16/24, R1 had no recollection of visiting any casino during the time periods in question. In an interview on 7/22/24, S4 said they enjoy visiting casinos. S4’s bank statements show many cash withdrawals made from ATMs at both of these casinos, both from S4’s personal and business accounts. In interviews, S4 and S4’s child, S1, said they drove R1 to ATMs to make withdrawals. Bank ATM video surveillance cameras captured S1 at an ATM withdrawing cash from R1’s account on 6/8/24. R1’s bank statements showed a withdrawal was authorized on that date in the amount of $900. Bank ATM video cameras captured S1 at another ATM withdrawing cash from R1’s account. R1’s bank statements showed a withdrawal was authorized on that date in the amount of $140. Bank ATM video surveillance cameras captured S4 at an ATM accessing R1’s account. R1 was not seen in any of the bank ATM surveillance captures reviewed by CCLD auditors. In an interview, S1 initially remembered accessing R1’s bank account at an ATM one time, and withdrawing $900. S1 claimed to have given the money to R1. When presented with video surveillance footage showing S1 accessing R1’s account a second time, S1 said that they had withdrawn $140 in cash, and did not know what had been done with the money. In an interview, S4 said that R1 accompanied them to the casino to withdraw cash.

[continued on 9099-C]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 11 of 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

NARRATIVE

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R1’s bank statements showed excessive purchases were made during R1’s time at Ohana Hospitality. R1’s bank statements show hundreds of dollars worth of purchases were made Costco. Records provided by Costco show that R1 was frequently purchasing more food than could reasonably be consumed by one person. Additionally, three meals per day are required to be served by all licensed RCFEs per 22 CCR 87464(f)(3) as part of the base rate charged to all residents. Purchases made with R1’s account at Costco include women’s sneakers, a women’s jacket, and women’s tights. One visit to Costco on 1/28/24 resulted in a charge of $653.36 to R1’s account for 24 cans of pineapple juice, four pounds of strawberries, dishwasher detergent, laundry detergent, and a boombox worth $499.99, among other various food items. In an interview, S4 said that R1 made Costco purchases for R1 but also for other residents. In an interview, S1 said that R1 would purchase food from Costco for R1 but also for everyone else at the facility. S1 also said that R1 had gifted them a massage pad and a jacket. The purchase for a $619.71 massage pad from R1’s account on 11/16/23 was verified through financial records. There was no record of this gift in facility records.

In an interview, S4 said they were not sure if others had access to R1’s accounts, but they suspected that others did have access, since S4 heard others thanking R1 for food and money. On 10/25/23, R1 paid $1,000 to a caregiver of Ohana Hospitality, S5, through Zelle. Multiple charges totaling $1,506.66 were made through DoorDash between 10/10/23 and 1/11/24. DoorDash records showed that S5’s phone number and email address were used to make the DoorDash account, but R1’s card number was used to make purchases. Food purchased was delivered to Ohana Hospitality, as well as three RCFEs located in Vallejo. S5 was associated to two of these Vallejo RCFEs. In an interview, S5 said they did not realize they had been using R1’s card to make these purchases, but admitted to accepting gifts from R1, and said other staff members accepted gifts as well. S5 initially said that staff of Ohana Hospitality did not handle resident monies, but eventually said that S4 and S1 would “constantly borrow money” from R1 to help pay for bills. According to S5, S1 gambled frequently, and S4 would refer to this borrowed money as advances on rent. Initially, S5 denied receiving any money from R1, but eventually admitted to receiving a $2,000 loan from R1 in cash and a $1,000 gift from R1 via Zelle. S5 claimed to have paid back the loan, but could not provide any evidence supporting this claim. No documentation was available regarding gifts provided to S5.

[continued on 9099-C]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 9 of 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

NARRATIVE

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R1’s medical records indicate that R1 was diagnosed with progressing, acute confusion on 5/26/23. On 7/7/23, R1 was diagnosed with memory loss, according to medical records. Notes from R1’s appointment on 7/7/23 indicate that R1 did not remember why they had made the appointment, and expressed concerns over their memory. On 8/2/23, R1 received a diagnosis of delirium, according to medical records. On 8/7/23, a R1 received a CT scan, which revealed “brain volume loss,” according to medical records. Notes from a telephone appointment show that although S4 told R1’s physician that R1 was not confused, the physician made a referral for R1 to a memory clinic for suspected dementia. On 2/19/24, R1 was diagnosed with major neurocognitive disorder, according to medical records. A needs and services plan for R1 dated 7/8/24 indicated that R1 began to grow confused and disoriented around late January 2024. During an interview with LPA Moleski on 7/16/24, R1 appeared disoriented and confused, and did not know where they were. On 8/28/24, R1 was admitted to a post acute care center, and was diagnosed with dementia. A medical assessment completed at the post acute care center on 9/10/24 indicated that R1 needed assistance from a caregiver in order to manage their finances. In an interview, S4 said that they had taken R1 to the hospital on an unknown date for a psychiatric evaluation. S4 said that R1 had begun saying there was someone in their room with them when there was not, and R1 would forget that he had already eaten. S4 said that they continued to take R1 to the bank to withdraw money even after these symptoms developed. S5 said that R1 was forgetful. In an interview, the physician who completed R1’s medical assessment dated 5/30/23 said that R1 had a mild cognitive disorder at the time and struggled in thought processes, although R1 could hold a conversation.

Regarding the allegation of illegal eviction:

All residents of this facility were relocated as of July 2024, at which point S4 was acting as the administrator of this facility. A sale was made of licensee Agnes Sumagit’s business to S4, effective May 1, 2023, which ultimately resulted in a forfeiture of license pursuant to HSC Section 1569.19. Several residents, including R1, were moved to a facility owned and operated by S4. A notice written by Sumagit regarding the sale dated 5/5/23 stated that “I will continue to operate and run my care home until the new owner [S4] will get their own license.” S4 never obtained their own license for this facility. S4 had applied for a license to operate, but withdrew their application as of 7/22/24.

[continued on 9099-C]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 10 of 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

NARRATIVE

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In an interview in July 2024, S4 admitted that they moved residents out of this facility so that they would not have to staff two facilities, and would instead only have to staff their own facility. 22 CCR Section 87224(a) states that licensees may only evict residents for certain specific purposes, none of which justify an eviction in order to ease staffing costs. After LPA Kimberly Viarella informed S4 of this, S4 said they “made a mistake, and did not know.” Residents are entitled to 30 days written notice prior to eviction, or, in the case of eviction due to the change of use of a facility, or due to forfeiture of license, they are entitled to 60 days written notice.

There were five residents living at this facility as of May 2024 (R1-R5). R1, who does not have any responsible parties, was moved to S4’s facility as of July 2024. R1 did not know where they were when LPA Moleski spoke with R1 on 7/16/24, and did not seem to know how they had gotten to their new facility. LPA Moleski reviewed R1’s file and did not observe any documentation of any form of written notice. Additionally, R1 did not have a new admission agreement filled out upon arrival at their new facility.

R3 was also relocated to S4’s facility. R3 died in July 2024, after moving. R3’s responsible party said that they did not receive anything in writing regarding the move, but said that R3 had agreed to move. R3’s responsible party was not sure if R3 received any written notice.

R4 was evicted from this facility. R4’s responsible party was provided a handwritten notice by S4 which read: “This paper states that [R4] is discharged from Ohana Hospitality as of May 26, 2024. Further this indicates that [R4] had cleared from any financial responsibility to the home and with the home vice versa.” The note was signed by S4 and R4’s responsible party. This notice does not contain all the information required of eviction notices per 22 CCR Section 87224 or HSC Section 1569.682. In an interview, S4 said that R4 was given the opportunity to move from this facility to the facility S4 owned and operated, but they were not planning on keeping this facility open, meaning that R4 would have to move.

[continued on 9099]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 7 of 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

NARRATIVE

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The department has determined the following as it relates to the allegations that a resident in care was financially abused by a facility staff person, and that a resident was illegally evicted from their home:

Based on interviews and record review, the above allegations are SUBSTANTIATED. A finding that the complaint allegations are substantiated means that the allegations are valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Sections 87468.2(a)(8) and 87224(a). Additional citations related to the above findings will be issued on a case management report. An exit interview was held with Sumagit. Appeal rights and a copy of this report were emailed to Sumagit to sign.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 11

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
07/16/2024 and conducted by Evaluator Vincent Moleski

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240716162206

FACILITY NAME:	OHANA HOSPITALITY		FACILITY NUMBER:	347004197
ADMINISTRATOR:	AGNES SUMAGIT		FACILITY TYPE:	740
ADDRESS:	5117 HEATHER RANCH WAY		TELEPHONE:	(916) 534-7707
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95742
CAPACITY:	0	CENSUS: 0	DATE:	02/07/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Agnes Sumagit		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident in care was sexually abused by a facility staff person

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Vincent Moleski and Kimberly Viarella and Licensing Program Manager (LPM) Stephen Richardson met with former licensee Agnes Sumagit virtually via Microsoft Teams to deliver findings on this complaint investigation. LPA Moleski explained the purpose of the meeting.
This investigation consisted of interviews, observation, and record review.

In an interview with LPA Moleski at a different facility, a former resident (R1) disclosed that they had previously had sex with a staff member of Ohana Hospitality (S4). In an interview with an investigator from the Community Care Licensing Division (CCLD), R1 appeared disoriented, and did not know where they were. R1 said that they had sex with S4 while living at this facility in a bush outside. R1 also said that they had sex with S4 at another facility. R1 claimed to have pushed S4 up against a wall in R1’s room and had sex in a closet. An LIC 602 for R1 dated 5/28/23 indicated that R1 was non-ambulatory and was not able to independently transfer to and from bed. [continued on 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

NARRATIVE

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In an interview, S4 said that R1 was moved from this facility on July 8, 2024. S4 said that while R1 was living at Ohana Hospitality, R1 was using a walker and a wheelchair, but stopped using the walker around late December 2023. S4 said that R1 told them that R1 loved them, and called S4 beautiful, but S4 said they would stop the conversation if R1 began to ask personal questions. S4 said that R1 masturbated frequently while living at this facility. S4 denied having any sexual relationship with R1. S4 said that they had kissed R1 on the forehead and cheeks. S4 said they do the same for all residents on their birthdays.

In an interview, S3 said that R1 is very confused and is not oriented to reality. S3 said that R1 will only ask S4 for assistance. S3 said that R1 prefers to be naked most of the time, which S4 does not like. S3 said that they have heard moaning and screaming coming from R1’s room. S3 said that S4 does not spend too long in R1’s room while assisting R1, and said they have never seen S4 acting inappropriately with residents.

In an interview, S2 said that R1 was flirty with them, and also that R1 wanted to marry S4. S2 said that R1 tried to kiss other residents, and wanted hugs from residents and staff members. S2 said that R1 was not engaged in any sort of relationship with anyone, and said that S4 had not engaged in any sexual relationship with R1.

In an interview, S6 said that they had not observed any staff members behaving inappropriately with any residents. S6 said that S4 had never engaged sexually with any residents.

In an interview, Sumagit said that she was not aware of any inappropriate behavior stemming from R1. Sumagit said that she had never seen S4 being affectionate toward residents, and was not aware of any inappropriate behavior on the part of S4.

Residents who were interviewed did not have information to share regarding R1 or the allegations in this complaint.

[continued on 9099-C]

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 11

Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
	VISIT DATE: 02/07/2025

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The department has determined the following as it relates to the allegation that a resident in care was sexually abused by a facility staff person:

Based on interview, record review, and observation, the above allegation is UNSUBSTANTIATED, which 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.

No deficiencies were cited regarding the above allegation. An exit interview was held and a copy of this report was emailed to Sumagit to sign.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240716162206

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: OHANA HOSPITALITY	FACILITY NUMBER: 347004197
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/07/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/14/2025 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	"... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: ... To be free from ... financial exploitation..." This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Former licensee agrees to submit a letter of acknowledgement regarding the section cited.
	8 9 10 11 12 13 14	Based on interviews and record review, R1 was financially exploited by S4, which poses an immediate health, safety, and/or personal rights risk.	8 9 10 11 12 13 14
Type A 02/14/2025 Section Cited CCR 87224(a)	1 2 3 4 5 6 7	"The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)." This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Former licensee agrees to submit a letter of acknowledgement regarding the section cited.
	8 9 10 11 12 13 14	Based on interviews and record review, residents of this facility were illegally evicted, which poses an immediate health, safety, and/or personal rights risk.	8 9 10 11 12 13 14

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: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

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