Follow-up on corrections·December 4, 2025

On 12/4/2025, Licensing Program Analysts (LPAs) Cynthia Tamayo and Avelina Martinez conducted an unannounced Case Management -Deficiency visit to the facility. LPAs met with facility administrator Isikeli Tuikenatabua (S2) and explained the purpose of the visit. Interview statements from two staff (S1 and S2), it was learned that unassociated individuals. On two separate accounts LPAs were informed two unassociated individuals were present at the facility. It was reported P1 and P2 were present at the facility the on or around 9/23/25 and 12/4/25. It was discovered that P1 is the former administrator/licensee at facilities 342700499 342700440 and 342700730, which were closed as of July 2025.Upon guardian and LIS roster review, it was observed that P1 and P2 are on probation and not associated to Legacy Lane Senior Living. A civil penalty applies for having individuals who are excluded and/or not associated to the facility. During site visit on 12/4/25 around 9:00 AM,LPA Martinez observed P2 and two other unassociated individuals were present outside of the facility. It was confirmed P2 was present in the facility on 12/4/25 and LPAs were informed by facility staff that P2 is at the facility approximately once per week to assist with maintenance work, and they are also called to order supplies and materials needs at the facility. S2 stated R1 called them on 9/23/25, stating “something happened”. S2 stated they were not working at the facility on the week of 9/20/25 due to working at another facility (Vita Bella Elderly Care) and that is why S2 called P1, in order to ask them to come to the Legacy Lane Senior Living in order to have a female speak with R1. S2 stated there was no other administrator or designated responsible person on site, only care staff, so they called P1, whom is their former employer to come to Legacy lane in order to assist with speaking to R1. CONTINUED ON 809-C LPA Martinez spoke with S1 over the phone at around 10:35 AM and S1 confirmed they are in New York and have been out of the facility since May 2025 and will return "soon". They will contact LPA Martinez back with a return date. Licensee stated they understood an informal office meeting will be scheduled. Moreover, LPAs provided guidance on the following: Reporting requests for missed medications and advised staff to maintain an accurate refusal log, and update resident Re-appraisal if the last one was done over 12 months ago or there was a change of condition, whichever occurs first. A civil penalty shall be assessed on December 04, 2025 , in the amount of $200.00 due to background clearance violations (Criminal Record Clearance 87355(e)(2)). Refer to LIC 421BG form for additional information. As a result of this case management visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809-D page. An exit interview was conducted with S2, and a copy of these LIC 809 reports, LIC 809-D page, LIC 421BG, and Appeals rights were provided to the facility.