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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 02/03/2022
Date Signed: 02/03/2022 11:55:35 AM

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:
342701122
ADMINISTRATOR:ORELLO, MELISSAFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 51DATE:
02/03/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Melissa OrelloTIME COMPLETED:
12:00 PM
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On February 3, 2022 at 9:25am Licensing Program Analyst (LPA) Chris Hopkins arrived at Legacy Oaks of Sacramento for the purpose of conducting an unannounced Pre-Licensing inspection. A risk assessment call was performed prior to entry verifying there were no active covid cases. LPA was screened for COVID-19 symptoms and temperature taken prior to touring the facility. LPA met with Administrator Melissa Orello and together conducted a tour of the facility.

LPA inspected the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature in 5 resident bathrooms, temperatures measured at 115 degrees F which meets the 105-120 degree Fahrenheit regulation. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications locked in medication cabinet. Cleaning supplies kept locked in laundry room. The facility has an approved LIC 808 mitigation plan on file and uploaded into FAS.

LPA reviewed the Component III orientation with Administrator. Component III orientation successfully completed.


LPA recommends moving forward with licensure. Exit interview was conducted and a copy of report provided to facility representative.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
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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