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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700217
Report Date: 08/31/2021
Date Signed: 08/31/2021 03:23:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2021 and conducted by Evaluator Bruce Jacobs
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20210426131837
FACILITY NAME:LEGASPI CARE HOMEFACILITY NUMBER:
342700217
ADMINISTRATOR:DOMINIC LEGASPIFACILITY TYPE:
735
ADDRESS:8055 DEER LAKE DRTELEPHONE:
(916) 429-1587
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:6CENSUS: 6DATE:
08/31/2021
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Dominic Legaspi, AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident is ordered to sleep in staff room.
Facility lacks of supervision.
Facility failed to provide required training.
INVESTIGATION FINDINGS:
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LPA Bruce Jacobs conducted an unannounced complaint visit at the facility and met with Administrators Dominic and Alice Legaspi to discuss and complete this complaint investigation. LPA provided findings regarding the allegations listed above. The investigation was conducted by LPA Jacobs and consisted of reviews of the facility records and interviews with facility management and staff. The residents and other witnesses were contacted and interviewed. Alta Regional Center Service Coordinators were contacted.

The complaint allegations listed above were investigated. The residents, facility staff and management and other witnesses were interviewed by LPA Jacobs and Alta Regional Center. Client file documentation was obtained and reviewed. Staffing schedules and records were obtained and reviewed as were training records. Based on interviews, inspections and file reviews that the allegations were unsubstantiated. LPA found no evidence that a client was directed or slept in a staff room or that the facility lacked supervision or failed to provide staff training. Staff providing medication assistance had compelted their training and all staff files reviewed had current CPR and Firsit Aid Training.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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 2
Control Number 27-AS-20210426131837
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: LEGASPI CARE HOME
FACILITY NUMBER: 342700217
VISIT DATE: 08/31/2021
NARRATIVE
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Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are determined to be UNSUBSTANTIATED.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations occurred
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2