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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 02/29/2024
Date Signed: 02/29/2024 11:30:42 AM


Document Has Been Signed on 02/29/2024 11:30 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 SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:SYLVE, ASHLEYFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 105DATE:
02/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ashley SylveTIME COMPLETED:
11:30 AM
NARRATIVE
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On 02/29/24, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced Case Management visit to this facility. The LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA) Ashley Sylve and a brief interview followed.

The DFA updated the LPA on the progress made in the areas of overall documentation, plans of correction, behavioral interventions/plans for residents who needed additional care and supervision, as well as improvements to the phone system at the facility. The DFA also stated that they were looking into alternatives to the Wanderguard system, as some residents refused or forgot to wear their Wanderguard.

LPA stated that during 3 out of 4 of her unannounced visits, the LPA did not observe any activities taking place in either Assisted Living or Memory Care. These visits took place on 2/15/24, 02/19/24, 02/21/24 and 02/27/24. There were activities scheduled for 2/27/24: Morning Movement: Chair Yoga, Creative Coloring, Seasonal Eats & Treats, and Audiobook Stories. All 4 activities were scheduled every Tuesday at the same time. Based on interviews conducted, no new activities have been introduced into the community in a very long time.

This LPA reviewed the printed schedules for activities for the months of 12/23, 1/24, and 2/24, there was a sharp decrease in the frequency and type of activities offered.

The DFA stated that the full time Activities Director left on 01/05/24. A new Director was hired approximately 3 weeks later, but then did not show up for work on their first day, 01/29/24. DFA also stated that they have interviewed other candidates, but have not filled the position as of yet.

LPA stated Legacy Oaks has a capacity of 160 residents. According to the California Code of Regulations, Planned Activities, 87219(f): In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities, and shall be given such staff
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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: 02/29/2024
NARRATIVE
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assistance as necessary in order for all residents to participate in accordance with their interests and abilities. The program of activities shall be written, planned in advance, kept up-to-date, and made available to all residents. The responsible employee shall have had at least one year of experience in conducting group activities and be knowledgeable in evaluating resident needs, supervising other employees, and in training volunteers.

This deficiency was cited on the LIC 809D page.

A copy of this report was provided along with Appeal Rights.

Exit interview.

SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/29/2024 11:30 AM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2024
Section Cited
CCR
87217(f)

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Planned Activities 87219 (f) In facilities licensed...full-time responsibility to organize, conduct and evaluate planned activities... The program of activities shall be written, planned in advance, kept up-to-date, and made available to all residents...
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Administrator stated they will work with the Assistant Activities Director to revamp and update current calendar. She will also secure outside venders to come into the facility 3x a week, while their search continues for a full time Activities Director.
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The facility did not ensure the above regulation as evidenced by:
Based on observation, an interview with the Designated Facility Administrator, and a review of records, they do not have a full time activities director as required.
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The activities will take place in both Assisted Living and Memory Care.
Administrator will submit pictures or residents participating at events to Licensing at kimberly.viarella@dss.ca.gov.

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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: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
LIC809 (FAS) - (06/04)
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