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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:58:15 PM

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
03/01/2022 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220301164616
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: 60DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Melissa OrelloTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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-Residents are being physically abused while in care.
-Resident was aggressively pushed while in care, causing injuries.
-Residents are being spoken to in an inappropriate manner while in care
-Medical attention for resident is not being sought in a timely manner
-Resident's medication is being stolen
-Medication is not being administered to resident(s) according to physicians instructions.
-Resident's are being fed unsanitary food.
-Facility has rats
INVESTIGATION FINDINGS:
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On May 12, 2022 at 1:30 PM, Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Hopkins met with Administrator Melissa Orello and explained the purpose of today's visit.

Regarding the allegation of Residents are being physically abused while in care, the Department found the following: based on interviews, it was determined that residents are not being physically abused. In particular 1 resident, Resident 1 (R1) conservator confirmed that R1 has never told her that he/she was abused verbally/physically. Also R1's conservator has never witnessed any marks on R1's body or witnessed any staff verablly abusing R1.

Regarding the allegation of Resident was aggressively pushed while in care, causing injuries, the Department found the following: based on interview and record review, it was determined...
Report continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
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
03/01/2022 and conducted by Evaluator Christopher Hopkins-Clarke
COMPLAINT CONTROL NUMBER: 27-AS-20220301164616

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: DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Melissa OrelloTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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-Facility has cockroaches
INVESTIGATION FINDINGS:
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On May 12, 2022 at 1:30 PM, Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Hopkins met with Administrator Melissa Orello and explained the purpose of today's visit.

Regarding the allegation of Facility has cockroaches, the Department found the following: based on interview and observation, it was determined that one room did have cockroaches. On 3/3/22 when LPA came to open the complaint, LPA witnessed one room being sprayed by terminix for cockroaches. Based on interview and observation, the preponderance of evidence standards has been met, therefore, the above allegation(s) is/are found to be SUBSTANTIATED.
Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099D during this visit.

Exit interview held, Appeal Rights discussed and given, Copy of report given.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20220301164616
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2022
Section Cited
CCR
87307(d)(2)
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87307(d)(2)Personal Accommodations and Services: The following space and safety provisions shall apply to all facilities: The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.
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Administrator has agreed to maintain contract with terminix as well as provide LPA with copy of service bill due Date 5/18/22.
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This requirement was not met by: Based on interviews and observation, the licensee did not ensure the facility was clean/sanitary and healthful environment. The facility has a cockroach infestation in one room. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20220301164616
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: 05/12/2022
NARRATIVE
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...it was determined that R1 was sent to the hospital for aggressive and combative behavior and never for any injuries. R1's medical records show no signs of trauma to the head area and was only in the hospital due to agitation from his/her diagnosis.

Regarding the allegation of Residents are being spoken to in an inappropriate manner while in care, the Department found the following: based on interview, it was determined that staff are not speaking to residents in an inappropriate manner. LPA interviewed residents and staff and nobody has witnessed any residents being spoken to in an inappropriate manner.

Regarding the allegation of Medical attention for resident is not being sought in a timely manner, the Department found the following: based on interview and record review, it was determined that staff sent out R1 for medical attention the same day it was brought to their attention. Administrator provided LPA with incident reports as well as hospital discharge reports. Medical records also confirm this. As for Resident 2 (R2), Administrator stated there has never been a resident here by that name.

Regarding the allegation of Resident's medication is being stolen, the Department found the following: based on record review and observation, it was determined that residents narcotics are all counted for. LPA observed Med-Tech count residents narcotics and reviewed Medication Administration Record which matched.

Regarding the allegation of Medication is not being administered to resident(s) according to physicians instructions, the Department found the following: based on record review, it was determined that the Medication Administration Record matches with what is the bubble pack/ prescription bottle.

Regarding the allegation of Resident's are being fed unsanitary food, the Department found the following: based on interview, it was determined that residents have never witnessed any bugs crawling on their food or have never seen or heard of bugs crawling on anyone's food. Staff have never witnessed this either.

Regarding the allegation of Facility has rats, the Department found the following: based on interview and observation, it was determined that staff and residents have never seen rats or signs of any rats in the facility. LPA walked around, and didn't see any signs of rats.
Report continued on LIC9099-C...
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20220301164616
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: 05/12/2022
NARRATIVE
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Based on interviews, observation and records reviewed, it is determined that the preponderance of evidence standard is not met, therefore these allegations are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted with Administrator Melissa Orello. A copy of this report was left with Administrator upon exit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5