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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 01/10/2024
Date Signed: 01/10/2024 04:17:56 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
12/26/2023 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20231226091718
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:MELISSA ORELLOFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 102DATE:
01/10/2024
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Ashley SylveTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not make sure residents’ rooms were cleaned
INVESTIGATION FINDINGS:
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On 1-10-24 at 4:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct an investigation for the allegation noted above. LPA met with executive director Ashley Sylve and explained the purpose of the visit. LPA Viarella conducted observations on 12-27-23 and 1-5-24. LPA also reviewed facility housekeeping schedules.
Allegation: Staff did not make sure residents’ rooms were cleaned. Based on observations conducted, LPA observed housekeeping carts and housekeeping staff on duty. An observation on 12-27-23 revealed room #33 to contain a dirty adult brief on the nightstand. The observation also revealed a malodorous environment within the memory care unit. Additionally, room #52 was observed on 1-5-24 to have moldy food in the microwave and shower which contained excessive dirt, shampoo bottle on the shower floor, shower nozzle hanging to the floor, and gloves left on the side of the shower. The 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 KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (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)
Page: 1 of 3
Control Number 27-AS-20231226091718
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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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 during the same investigative period. An exit interview was conducted with and a Ashley Sylve and a copy of this report was provided to Ashely. Appeal rights provided.
SUPERVISOR'S NAME: Liza KingTELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael BilgerTELEPHONE: (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