342701122-7-7-2023-27-AS-KHOS-CTMNDM-20230711102234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 07/07/2023
Date Signed: 07/07/2023 10:31:30 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2023 and conducted by Evaluator Ruth Wallace

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230705153135

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342701122
ADMINISTRATOR:	AUDRE SMITH		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 94	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	07:35 AM
MET WITH:	Melissa Orello - Administrator		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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Facility air conditioning system is not working properly
Facility is not free of the smell of cigarette smoke

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced complaint inspection visit in regards to a complaint investigation with the above allegations. LPA met with Administrator and explained purpose of visit. There are currently 68 residents in assisted living and 26 residents in the memory care unit.

During this inspection visit LPA Wallace interviewed residents (R1-R2) and staff (S1-S4) (See confidential name list LIC-811 dated 7/7/23) LPA inspected the facility including resident rooms, kitchen, common areas, activities room, and outdoor areas. LPA obtained the following documents: maintenance records for air conditioning system and facility monthly air conditioning maintenance schedule.

Continued on 9099-C Page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230705153135

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 SACRAMENTO	FACILITY NUMBER: 342701122
	VISIT DATE: 07/07/2023

NARRATIVE

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Continued from 9099 - Page 2

The first allegation: Facility air conditioning system is not working properly.
Based on LPA observations of air conditioning system (the indoor temperature was set at 62 F for dining area and 65 F for the rest of the facility), maintenance records, tour of facility, and interviews, the allegation of facility air conditioning system not working properly is UNSUBSTANTIATED.

The second allegation: Facility is not free of the smell of cigarette smoke.
Based on LPA observations of smoking area in the back of building, residents are leaving the door open which can allow some smoke to lingerie in the short hallway before exit to smoking area. LPA did not observe the odor to be long and no resident rooms are in that short hallway before entering memory care unit. LPA tour of facility, and interviews, the allegation of facility is not free of the smell of cigarette smoke is UNSUBSTANTIATED.

The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation(s) are found to be UNSUBSTANTIATED. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may
have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s)
occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies cited.

An exit interview was conducted with Administrator and a copy of
9099, 9099-C, Appeal Rights, and LIC 811(Confidential Names) was provided

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 253-4746
LICENSING EVALUATOR NAME: Ruth Wallace	TELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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