342700597-3-18-2021-27-AS-KHOS-BZFMLS-20210325094249

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700597
Report Date: 03/18/2021
Date Signed: 03/18/2021 11:54:54 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/26/2020 and conducted by Evaluator Mai Thao

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20201026163142

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342700597
ADMINISTRATOR:	ARMSTRONG, ANDREA		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 42	DATE:	03/18/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Vicki Kaiser, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident not administered medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mai Thao conducted an unannounced complaint phone call to the facility today and spoke with Vicki Kaiser, Administrator. LPA explained purpose of call is to deliver findings for the above allegation. LPA explained the reason a physical visit was not conducted was due to COVID-19.

During today’s phone call, LPA delivered findings.

(Continued 812-C………)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (530) 895-5805
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

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

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20201026163142

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: LEGACY OAKS OF SACRAMENTO	FACILITY NUMBER: 342700597
	VISIT DATE: 03/18/2021

NARRATIVE

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Resident not administered medication as prescribed

During the investigation, LPA conducted interviews and reviewed records. Staff stated in interviews that medications were always given during their shift. Staff who assist residents with self administered medications stated in interviews that the Medication Administration Record (MAR) is used to document that medications were administered. LPA observed a random sample of resident MAR and medications were signed as being administered. LPA also review the facility’s medication policy and it states that the MAR is used to indicate that medications were administered. Majority of resident stated in interviews that they receive their medications and have not missed any medications. Majority of residents interviewed stated that they were given their medications and not missed any. Resident 1 (R1) stated R1 has been living at the facilities for 2 years. R1 stated that sometimes R1 has to ask for medications during the NOC shift and there is always a staff available to assist with R1’s medications. R1 stated that R1 have never missed any medications. Administrator Vicki stated in interviews that Administrator has only been employed at the facility for 3 months and does not know of any missed medications during October 2020. Administrator stated that staffing has been challenging since the pandemic started, but there is always a Medication Technician during each shift to assist residents with medications. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No citations were observed in the investigation of this complaint investigation. An exit interview was conducted and TWO (2) copies of this report was sent via E-Mail to Administrator, Vicki Kaiser. ONE (1) copy to be signed and returned to LPA and ONE (1) copy to be signed and kept at the facility for records.

SUPERVISOR'S NAME: Rayna L Bryson	TELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Mai Thao	TELEPHONE: (530) 895-5805
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

LIC9099 (FAS) - (06/04)

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