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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 06/23/2023
Date Signed: 06/23/2023 08:39:11 AM


Document Has Been Signed on 06/23/2023 08:39 AM - 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: 94DATE:
06/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Tasha KeittTIME COMPLETED:
08:30 AM
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Licensing Program Analyst (LPA) Pang Lee and Licensing Program Manager (LPM) Czarrina Camilon-Lee arrived at the facility unannounced on 06/23/2023 at 8:00 AM to conduct a case management visit. LPA Lee and LPM Camilon-Lee met with Memory Care Coordinator, Tasha Keitt and explained the purpose of the visit.

The purpose of this visit is to follow-up in regards to the facility not having a current qualified administrator in place. Executive Director, Melissa Orello’s administrator certificate expired on 03/28/2023 and her administrator re-certification was not post marked until 04/07/2023. Based on Department review, Melissa Orello can continue to be the administrator to this facility since she has not technically forfeited her administrator certificate. The Department will recognize her as the administrator to this facility until she obtains her administrator certificate.

LPA requests that once Melissa Orello obtains her administrator certificate to let the Department know and to provide a copy of it as soon as possible.

An exit interview was held, and a copy of this report was given to the facility at the end of the visit.

No deficiency is cited.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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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