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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700597
Report Date: 11/19/2021
Date Signed: 11/19/2021 12:42:06 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:MELISSA ORELLOFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 53DATE:
11/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Marlene BremerTIME COMPLETED:
12:45 PM
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On November 19, 2021 at 11:21am Licensing Program Analyst (LPA) Chris Hopkins arrived at Legacy Oaks of Sacramento and conducted an unannounced case management visit. LPA met with Assistant Executive Director Marlene Bremer and stated the purpose of this visit.

Assistant Executive Director and LPA toured the facility. LPA observed some residents eating lunch, and maintaining social distancing. LPA observed kitchen staff, caretakers, house keepers, med techs, and office staff all wearing facemasks properly. LPA observed a fully stocked PPE supply room. There are proper signs related to hand washing, social distancing, and how to don and doff posted throughout the facility. LPA observed employee and visitors logs to be complete with temperature, name, time in and time out sections all filled out properly. Staff training is conducted once a month on average, and if need be management conducts training when necessary. LPA reviewed the LIC 808 mitigation plan. The facility does allow visitors whether or not they are vaccinated. If vaccinated or have a negative test within 72 hours, visitors are allowed to visit in the residents room. If not vaccinated or no test has been done, visitors and residents must wear masks and visit outside, maintaining their social distancing.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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