342700597-10-1-2021-27-AS-KHOS-C7QUHT-20211012153628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700597
Report Date: 10/01/2021
Date Signed: 10/01/2021 03:01:52 PM

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
09/08/2021 and conducted by Evaluator Mohamed Filouane

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210908114453

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342700597
ADMINISTRATOR:	GREGORY GREENE		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 58	DATE:	10/01/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Lori Knoll and Melissa Orello		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility is mismanaging resident's medications

INVESTIGATION FINDINGS:

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On 10/01/21, Licensing Program Analyst (LPA) Mohamed Filouane, conducted a follow-up 10-day complaint on-site inspection. LPA entered the facility and had his temperature taken and answered a COVID-19 questionnaire by a staff member, following the facility's health and safety procedures. LPA Filouane then met with Executive Director Lori Knoll and Executive Director from a sister facility, Melissa Orello. LPA Filouane explained the purpose of the visit, reviewed the allegations, and delivered the findings.

Regarding the allegation of the facility mismanaging a resident's medication, LPA Filouane interviewed the Business Office Manager and the Executive Director from the sister facility, interviewed the resident in question, as well as reviewed the medication logs of residents in the facility. The resident in question denied the allegation. The resident medication logs were observed as accurate. The BOM and Executive Director from the sister facility denied the allegation. The BOM stated staff are always available and that there is a previous administrator who holds an RCFE license available in the facility as well until late in the evenings for PRN medication. After review, this allegation is unsubstantiated.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with the Administrator. The Administrator will receive this LIC9099 report through email to sign.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Mohamed Filouane	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021

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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