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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 02/06/2024
Date Signed: 02/06/2024 03:20:50 PM


Document Has Been Signed on 02/06/2024 03:20 PM - 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 SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:SYLVE, ASHLEYFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 103DATE:
02/06/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ashley SylveTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on a plan of correction developed during a visit on 1/24/24. LPA Moleski met with facility administrator Ashley Sylve and explained the purpose of the visit.

On 1/24/24, LPA Moleski cited this facility per 22 CCR Section 87411(f) regarding three staff members (S1-S3) who did not have health screenings on file, with an agreed-upon plan of correction due date set for 2/2/24. LPA Moleski did not receive proofs of correction or correspondence regarding corrections progress prior to the due date.

During this visit, LPA Moleski was provided proof of S1's resignation prior to the due date. LPA Moleski reviewed a health screening for S2 dated 2/1/24 which did not include a tuberculosis skin test or a chest x-ray as required per 22 CCR Section 87411(f). Sylve could not provide a health screening for S3 during this visit.

As a result, a civil penalty for failure to correct is being assessed in the amount of $100 per day for the period of 2/3/24 through 2/6/24 for a total of $400. Further civil penalties may be assessed if the deficiency is not corrected.

No deficiencies were cited during this visit. An exit interview was held with Sylve. Appeal rights and a copy of this report were left with Sylve.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Vincent MoleskiTELEPHONE: (559) 365-5294
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2024
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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