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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 02/21/2024
Date Signed: 02/21/2024 06:34:51 PM


Document Has Been Signed on 02/21/2024 06:34 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: 105DATE:
02/21/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Ashley SylveTIME COMPLETED:
06:45 PM
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On 02/21/24, Licensing Program Analyst (LPA), Kimberly Viarella made an unannounced case management visit to this facility to follow - up on the concerns previously discussed on 11/09/23. Upon arrival, the LPA identified herself, stated the purpose of the visit and asked to meet with the Designated Facility Administrator (DFA). LPA met with Ashley Sylve. A brief interview followed.

DFA shared news that a new nurse had been hired and was completing their Relias training. The DFA stated that she would be conducting an interview for a new Activities Director tomorrow, 02/21/24. She also stated that a $40,000 contract had been signed to build a new designated smoking area / shelter for residents. In addition, the facility just obtained a new contract for a linen service. This would allow existing housekeeping staff to focus on the personal laundry of the residents in care.

DFA provided an updated LIC 500 along with contact information for all employees. LPA compared printout of the roster of 107 associated individuals from Guardian to the 60 employees listed on the LIC 500 to ensure that all employees had completed and passed their necessary background checks.

Due to time constraints, this LPA will return at a later date to continue this case management. No deficiencies were observed during this visit.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024
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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