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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 06/20/2023
Date Signed: 06/20/2023 04:12:16 PM


Document Has Been Signed on 06/20/2023 04:12 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
CCLD Regional Office, 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:
06/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Alicia DuchineTIME COMPLETED:
04:30 PM
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On 6/20/23 at 1:40pm Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced case management incident inspection to ensure the health and safety of residents after receiving a report of a small fire in the facility laundry room on 6/17/23. LPA met with staff Member Alicia Duchine and together conducted a tour of the facility and to ensure there are no existing threats to the health and safety of residents in care.

LPA walked into the facility and observed no noticeable smell of smoke. The facility appeared clean and odor free. LPA did not observe any lingering effects from the fire including but not limited to smoke, floor or ceiling damage. LPA did observe the laundry room where the fire started. Per staff member reports the housekeeper (not present during today's inspection) observed a blouse in the dryer catch fire and immediately received support from another housekeeper who extinguished the fire with two fire extinguishers. The fire alarm went off as designed and all residents were evacuated safely until it was determined to be safe to return by the fire marshal.

Sacramento Metro Fire Department inspected the alarm and determined the facility must have the alarm reinspected sooner than the facility had scheduled with bay alarm the facility complied and had the fire alarm inspected and cleared on 6/19/23 after the reported incident. The facility has scheduled fire mitigation with Servicemaster.

Per California Code of Regulations, Title 22, there were no deficiencies cited during this inspection.

Exit interview 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: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
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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