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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 06/08/2023
Date Signed: 06/08/2023 02:07:35 PM


Document Has Been Signed on 06/08/2023 02:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:AUDRE SMITHFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 93DATE:
06/08/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Alicia DuchineTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Pang Lee arrived at the facility unannounced on 06/08/2023 at 08:05 AM to conduct a proof of correction (POC) case management visit. LPA Lee met with administrator Alicia Duchine and explained the purpose of the visit.

The purpose of this visit is to follow-up on a plan of correction (POC) that were due on 05/19/2023. During today's visit, LPA Lee toured and inspected the facility to ensure deficiency previously cited on 05/16/2023 have been corrected. Regional Manager Melissa Orello sent POC to LPA Lee on 05/18/2023. During today's visit, LPA Lee observed sufficient 2 days non-perishable food in the facility. LPA Lee also reviewed administrator qualifications. During today's visit, Administrator Alicia Duchine provided LPA Lee with a current updated LIC 501 Personnel Report with her education and college units.

Based upon this inspection, LPA Lee observed the following:
I. Deficiency cited under Title 22 Regulation 87405(f) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee.

2. Deficiency cited under Title 22 Regulation 87555(b)(26) has been cleared. Licensee complied with the terms of the POC by POC due date. A POC letter was generated and provided to the licensee.

An exit interview was conducted and a copy of this report LIC 809 was given to the facility at the end of the visit. Facility was provided POC cleared letter.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
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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