342701122-11-6-2023-27-AS-KVIA-CXBMG8-20231106083527

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 11/03/2023
Date Signed: 11/06/2023 08:35:37 AM

Document Has Been Signed on 11/06/2023 08:35 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342701122
ADMINISTRATOR:	MELISSA ORELLO		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 105	DATE:	11/03/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Melissa Orello		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/03/23 Licensing Program Analyst, (LPA) Kimberly Viarella made an unannounced case management visit to this facility. This visit was prompted by a phone call from the Designated Facility Administrator, Melissa Orello, who notified Community Care Licensing (CCL) this morning about a text their Director of Memory Care received the previous evening. The LPA identified herself upon arrival and asked to speak with the Designated Facility Administrator. LPA met with Melissa Orello, the Designated Facility Administrator and Regional Director of Operations West (RDOW), and a brief interview followed. On 11/02/23 the Director of Memory Care, Alicia Ducine, received an anonymous text message that contained video footage of 3 residents in memory care. Two of the residents were in common areas, the third was in the shower. This video was posted to Instagram along with commentary by the staff member who took it. The Director of Memory Care was unable to reach the RDOW or the Assistant Executive Director by phone until the following morning. When the RDOW was notified and provided with the video footage on the morning of 11/03/23, the Assistant Director had already notified the responsible parties for the 3 residents involved. The RDOW proceeded to call the Ombudsman, this LPA, and the Sacramento Sheriff's Department. She then began working on the SOC341s. At approximately 11:13 AM the RDOW called the employee (S1) seen at the end of the video and asked if S1 had posted any videos of residents on Instagram. S1 denied posting anything. The RDOW told S1 to take the video down immediately. S1 said they did take it down. The RDOW asked if S1 would be for their 2:00 PM shift and S1 replied yes. The RDOW said they looked forward to seeing them later. The RDOW had the termination paperwork and S1's last check ready to be delivered and had scheduled the police to be present at the start of S1's shift.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 11/03/2023

NARRATIVE

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Earlier that morning, S1 had texted the Assistant Director to call out stating that they felt uncomfortable about coming in because of Covid. (This LPA learned that there was 1 resident with Covid and 5 staff who were out with Covid.)

Two police officers arrived at the facility at approximately 1:30 PM. They were parked in front of the building. S1 did not report for their 2:00 PM shift.

This LPA was given a tour of Memory Care by Marlene Bremer, the Executive Director of Park Rose of Fairfield, a sister facility, who was present today to help out. LPA visited and spoke to 2 of the three victims, the third was seen to be asleep. The LPA identified herself and did not bring up the incident, but both residents were communicative and appeared to be unaware that they had been videotaped or that the video had been posted to social media.

The LPA conducted additional staff interviews while at the facility and spoke to the Ombudsman who was also present at the time. The Director of Memory Care was not interviewed because it was her day off.

The Police Case Number for this incident is: 23-351600.

The following documents were requested during this visit:
LIC 500
Resident Roster
Staff schedules for Memory Care for October and November
SOC341
LIC624
Hours worked log for October 22 - November 2 for Memory Care

Due to time constraints and the ongoing investigation, this case management will be continued at a later date. No deficiencies were cited during today's visit. A copy of this report was provided.

Exit interview.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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