342701122-1-10-2024-27-AS-KHOS-CZZM7L-20240131082142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 01/10/2024
Date Signed: 01/10/2024 04:15:58 PM

Substantiated

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
11/20/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20231120151048

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: 102	DATE:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Ashley Sylve		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not ensure that facility is clean

INVESTIGATION FINDINGS:

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On 1-10-24 at 3:10pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with executive director Ashley Sylve and explained the purpose of the visit. During this investigation, LPA interviewed 6 staff members and 3 residents in care. LPA also conducted a facility observation on 11-30-23. An additional facility observation was conducted by LPA Viarella on 11-21-23 and 12-27-23. Two additional residents were interviewed by LPA Viarella on 11-21-23. LPA Bilger reviewed facility file documentation including housekeeping schedule and pest control agreement.

Allegation: Staff do not ensure that facility is clean. LPA conducted interviews and observations as noted above. LPA observed housekeeping carts and housekeeping staff on duty. Interviews conducted revealed a previous presence of insects in at least 2 resident rooms, however, the facility has maintained a pest control service as documented since 1/31/23 with regular service conducted at least two times per month. Housekeeping schedule reviewed indicates a regular on-going cleaning schedule covering all facility rooms, bathrooms, hallways, and other common areas of facility. {Cont. on 9099C}

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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-20231120151048

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: 01/10/2024

NARRATIVE

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An observation on 12-27-23 revealed room #33 to contain a dirty adult brief on the night stand. The observation also revealed malodorous environment within the memory care unit which included the odor of urine in the common areas utilized by residents and staff. As a result, the preponderance of evidence standard is not met, and this allegation is SUBSTANTIATED.

Licensee was previously cited on 1-10-24 for violation of Section 87303(a) pertaining to complaint # 27-AS-20231122103137 within the same investigative period. An exit interview was conducted with Ashley Sylva and a copy of this report was provided to Ashley. Appeal rights provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
11/20/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20231120151048

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: 102	DATE:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Ashley Sylve		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not accord residents in care privacy

INVESTIGATION FINDINGS:

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On 1-10-24 at 3:10pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with executive director Ashley Sylve and explained the purpose of the visit. During this investigation, LPA interviewed 6 staff members and 3 residents in care. LPA also conducted a facility observation on 11-30-23. An additional facility observation was conducted by LPA Viarella on 11-21-23 and 12-27-23. Two additional residents were interviewed by LPA Viarella on 11-21-23.
Allegation: Staff do not accord residents in care privacy. LPA conducted interviews and observations as noted above. Interviews conducted did not reveal corroborated statements of infringement on residents’ privacy including speaking of residents’ personal information in hallways or other common areas of the facility. LPA observed staff interaction in hallways and other common areas of facility including medication cart locations, dining room, and activity room. Based on observations conducted, it was revealed that staff knocked on doors prior to entering and allowed additional private spaces for residents. LPA did not observe staff speaking of residents in the hallways and other common areas of the facility. As a result, the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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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