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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700597
Report Date: 08/21/2020
Date Signed: 08/25/2020 12:57:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342700597
ADMINISTRATOR:ARMSTRONG, ANDREAFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: DATE:
08/21/2020
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andrea Armstrong- AdministratorTIME COMPLETED:
11:15 AM
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On 08/21/2020 at approximately 10:00AM Licensing Program Analyst (LPA) McCrory tele-visited the Legacy Oaks of Sacramento Facility via FaceTime due to COVID-19 precautionary reasons. The tele-visit was conducted as an announced Case Management Health and Safety Check with Administrator (Admin) Andrea Armstrong.

Below is pertinent information regarding the visit:
  • Boxes of Personal Protective Equipment (PPE) stored throughout the facility include; gowns, masks, sanitizer wipes, COVID-19 tests, Sanitizer, disinfectant spray, gloves, shoe covers, goggles, face shields, nano masks, etc.
  • Signage posted for Social Distancing, hand washing, cough etiquette, COVID-19 symptoms and reporting
  • Thermostat temperature at main entrance - 72 Degrees Fahrenheit
  • Thermostat temperature at main hallway - 70 Degrees Fahrenheit
  • Three Resident rooms visited: Resident #1 states temperature is "good". Resident #2 not in room and room thermostat read 74 Degrees Fahrenheit. Resident #3 states they are "cold all the time" and the thermostat temperature is 77 Degrees Fahrenheit. Resident #3 states the temperature was set by himself for his own comfort.
  • Non-perishable food supply includes applesauce, cookies, pudding, Ritz crackers, Chex Mex, and more.
  • Perishable food supply includes bananas, yogurts, lettuce, prune juice, a variety of meat, watermelon, and more.
  • Physical plant appears clean and free of debris.
  • Kitchen appears clean and well stocked with adequate food supply.
  • Medical room door locked with locked cabinets inside of room for medicine storage.
  • Resident rooms appeared clean and free of debris.
  • Residents appear comfortable with temperature; no signs of sweat or flushed face/ cheeks.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jasmine McCroryTELEPHONE: (916) 214-5020
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: LEGACY OAKS OF SACRAMENTO
FACILITY NUMBER: 342700597
VISIT DATE: 08/21/2020
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Admin states the chiller affects the temperature in the bedrooms. On the weekend of 08/15/2020 temperatures reached above 100 Degrees Fahrenheit outside and the chiller was not working at full capacity. This caused an increase in temperature within the facility and issue was resolved by maintenance the same day.

Admin states snacks a provided by Medical Technicians (Med-Techs) during medicine distribution 2 times a day.

Admin states Residents may requests snacks at any time and are able to eat a variety of options.

There are no deficiencies cited at this time.

Exit interview conducted, copy of the report was mailed to Licensee due to COVID-19 precautions.
Two copies sent to the Licensee with the request of a signed copy to be returned to the department.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jasmine McCroryTELEPHONE: (916) 214-5020
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020
LIC809 (FAS) - (06/04)
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