Office review·March 10, 2026

An Office Meeting was held on March 10, 2026, at 10:00 AM via Microsoft TEAMS. Present were Licensing Program Manager Stephen Richardson (LPM), Licensing Program Analysts Christina Valerio, Reza Jamaly and Arvin Villanueva (LPAs), and Licensee, Adi Lina Tuiloma. The purpose of this meeting was to discuss facility’s failure to provide requested documentation, including staff timesheets for Administrator, Tevita Kaloulasulasu, and to address additional concerns regarding staffing expectations, payroll practices and documentation retention. Failure to provide requested documentation: It was discussed with Adi Lina the facility’s failure to provide requested documentation following an initial request made on February 9, 2026 for staff timesheets and documentation that provide proof of Administrator’s actual work hours. Despite multiple follow-ups, the requested documents had not provided within a reasonable timeframe. Per last office meeting on February 26, 2026, Adi Lina had stated she will have these documents submitted to the Department by March 2, 2026. An email reminder was sent to Adi Lina on Mach 4, 2026 but she did not respond. Adi Lina stated that she had received some recent timesheets but was still waiting for timesheets from September 2025 and October 2025. Per Adi Lina, the timesheets are typically completed by employees as hard copies when they work on their scheduled shift and are maintained in a file at the facility. However, Adi Lina stated that the hard copies for the Administrator could not be located. {1 of 3} The Department had concerns regarding the facility’s ability to maintain and produce documentation when requested by the Department. Adi Lina was informed that, as a licensee of the facility, she holds ultimate responsibility for facility operations, including maintaining staff records and ensuring that required documentation can be produced in a timely manner. A delay of one month would not be considered timely. It was also discussed to Adi Lina the importance of communication with the Department. Adi Lina was informed that if there are any barriers to providing requested documents, as a licensee, she is expected to communicate timely with the LPA and can request an extension. Adi Lina failed to respond to emails timely. Regarding administrator and payroll: Adi Lina stated that Tevita Kaloulasulasu has continuously served as the facility’s administrator since it was licensed. Adi Lina stated that Tevita is paid in cash and that no W-2 forms have been issued to him. Adi Lina stated that she has been paying him directly in cash without withholding taxes. Staffing concerns: It was discussed that prior visits to the facility, the facility appeared to have only one staff on duty during these visits, despite the requirement for two staff, based on the NCC meeting held on September 25, 2026. Adi Lina stated that she has experienced difficulties retaining staff and that some employees have walked off or called sick. Adi Lina stated that when this occurs, she goes to the facility and serve as a second staff. Administrator work schedule: Adi Lina stated that Tevita is scheduled at this facility on Mondays, Wednesdays, and Fridays from 7am to 7pm. Adi Lina explained that Tevita is expected to be at this facility during scheduled time, unless there is a change and Tevita will come the following day. {2 of 3} The licensee agreed to the following: Adi Lina will submit all available timesheets for Tevita by close of business day today. Adi Lina will provide the remaining timesheets for September and October by Friday, March 13, 2026. Adi Lina will submit a written plan outlining how the facility will improve documentation retention and accessibility, including procedures to ensure that requested documents can be produce in a timely manner. Adi Lina will submit an updated LIC500 Personnel Reports for each facility operated by her, identifying the staff currently assigned to each facility. Adi Lina will ensure the facility maintains two staffing ratio in accordance with the NCC meeting. The Department will do the following: The Department will continue to conduct quarterly monitoring visits to this facility. Adi Lina was informed that failure to comply with documentation requests and staffing requirements may result in further enforcement action. Based on today’s meeting, deficiencies are being cited. Exit interview was conducted with Adi Lina, who acknowledged the discussion and the expectations outlined above. A copy of this report and appeal rights were provided via email with a request for signature and confirmation of read receipt. {3 of 3}