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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 10/06/2023
Date Signed: 10/06/2023 11:59:07 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230815154244
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: 104DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Melissa OrelleTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility air conditioning system is not working properly.
INVESTIGATION FINDINGS:
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On 10/06/2023 at 11:00PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with administrator Melissa Orelle and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 104. A brief interview with conducted with administrator.

Allegation: Facility air conditioning system is not working properly
It was alleged that the facility air conditioning system is not working properly. This investigation consisted of records reviewed, observations, interviews with staff and residents. During the investigation, records reviewed revealed that the facility is getting regular maintenance services through Jerico Mechanical. Jerico Mechanical Services report dated on 04/13/2023 states “Checked till low charge, changed filters on HVAC air, handlers. All units working good" and “Other issues may be arising, but it is holding temperature.”
Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
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
Control Number 27-AS-20230815154244
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LEGACY OAKS OF SACRAMENTO
FACILITY NUMBER: 342701122
VISIT DATE: 10/06/2023
NARRATIVE
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 In addition, it was learned that on 06/29/2023 the facility had CJC Heating and Air come out to the facility to service the AC unit. CJC Heating and Air completed a refrigerant charge, changed compressor oil, and changed 4 dryer filters. Interviews conducted show that 7 out of 10 residents had no concern regarding the temperature in the facility. Furthermore, during the complaint visit on 08/17/2023, 08/29/2023 and 10/03/2023, LPA Lee observed the facility to be comfortable and the facility temperature was within the regulations of 78 degrees Fahrenheit and 85 degrees Fahrenheit.

The investigation revealed the preponderance of evidence standards has not been met; therefore, the above allegation are found to be UNSUBSTANTIATED. A finding that the complaint allegation is 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.

There was no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2023 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230815154244

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: 104DATE:
10/06/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Melissa OrelleTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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No qualified staff in the Kitchen.
Facility does not have sufficient staff to meet the needs of the residents.
INVESTIGATION FINDINGS:
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On 10/06/2023 at 11:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with administrator, Melissa Orelle and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegations above. The current census is 104. A brief interview was conducted with administrator, Melissa Orelle.

Allegation: No qualified staff in the Kitchen

It was alleged that the facility does not have a qualified staff in the kitchen. This investigation consisted of records reviewed, observations, interviews with staff, residents and with Crandall Corporate Dietitian. During the investigation, it was learned on 10/05/2023 at 3:25 PM, that from March 2021 to present the facility did not receive any register dietitian consulting visit from Crandall. Furthermore, on a complaint follow-up visit on 10/03/2023, LPA Lee requested from the facility documentation of annual reports from Crandall to show that the facility is receiving regular consulting with a register dietitian.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20230815154244
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LEGACY OAKS OF SACRAMENTO
FACILITY NUMBER: 342701122
VISIT DATE: 10/06/2023
NARRATIVE
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Chief, Andrew Dawson provided LPA Lee Crandall Menu for Spring/Summer 2023. The menu provided to LPA Lee had three ripped at the edge of the corners; therefore, LPA Lee could not distinguish the date the menu was generated or approved. On 10/03/2023 during a complaint follow-up visit LPA Lee requested a current Crandall Menu. On 10/05/2023 at 3:25 PM it was also learned that on 05/15/2023, the facility stopped receiving menu services from Crandall due to nonpayment. It was also learned that on 10/04/2023 the facility called Crandall to pay for the quarterly bill and have services reinstated. On 10/05/2023 at 9:06 AM, Chief Andrew emailed LPA Lee the current Crandall menu that was approved on 10/05/2023. The facility did not ensure a provision is made for regular consultation from a qualified person. Moreover, the facility could not provide LPA Lee with a written record of the frequency, nature and duration of the consultant’s visits.
The department has determined the following as it relates to the allegations that the does not have qualified staff in the Kitchen. Based on interviews and recorded review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

Allegation: Facility does not have sufficient staff to meet the needs of the residents

It was alleged that the facility does not have sufficient staff to meet the needs of the residents. This investigation consisted of records reviewed, observations, interviews with staff and residents. The investigation revealed that 7 out of 10 residents had concerns with not getting medications as prescribed. On 08/17/2023 complaint visit, it was learned that on 08/15/2023 resident 1 (R1) did not receive (R1) dinner until (R1) went to the kitchen to question staff. (R1) then was given a peanut butter sandwich.

The department has determined the following as it relates to the allegation that the facility does not have sufficient staff to meet the needs of the residents. Based on interviews and recorded review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.



Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D page, and appeals right document were provided to the facility.


SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20230815154244
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: LEGACY OAKS OF SACRAMENTO
FACILITY NUMBER: 342701122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
87555(17)
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87555(17) General Food Service Requirements
(17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility.

This requirement is not met as evidenced by:
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The licensee agrees to read regulation 87555(17) and submit a signed declaration of understanding of regulation cited. Administrator, Mellisa Orelle provided LPA Lee a copy of Community Subscription Agreement Crandall Menus signed on 10/06/2023.
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Based on interviews and records review, licensee did not comply with the section cited above. The administrator did not ensure the facility ensure a provision is made for regular consultation from a qualified person. The administrator also did not ensure the facility has written records of the frequency, nature and duration of the consultant’s visits, which poses/posed a potential health, safety, or personal rights risk to persons in care.
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Administrator also provided LPA Lee a copy of Community Agreement for dietary consulting with Crandall signed on 10/06/2023. Administrator will ensure that these services does not have any interrupt at any given time. Administrator will email POC to LPA Lee by POC due date of 10/13/2023 by 5:00 PM end of day.
Type B
10/13/2023
Section Cited
CCR
80072(a)(2)
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80072(a)(2) Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
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Administrator agrees to read regulation 80072(a)(2) and submit a signed declaration of understanding. The administrator will email POC to LPA Lee by POC due date 10/13/2023 by 5:00 PM end of day.
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Based on LPA observations, records review and interviews the administrator did not comply with the section cited above. The administrator did not ensure that residents are receiving medications as prescribed and ensure that resident are getting meals as per admission agreement contract, which poses/posed a potential health, safety or personal rights to person 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) 263-4700
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5