342701122-2-16-2024-27-AS-LKIG-D2V32B-20240227165137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 02/16/2024
Date Signed: 02/16/2024 04:15:35 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 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: 105	DATE:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Ashley Sylve		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not meet residents’ hygiene needs
Staff did not provide adequate food service

INVESTIGATION FINDINGS:

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On 2-16-24 at 2:38pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegations noted above. LPA met with Administrator Ashley Sylve and explained the purpose of the visit. During this investigation, LPA conducted facility observation on 1-30-24. Additional observations were conducted by LPA Viarella on 12-27-23 and 1-5-24. LPA also reviewed facility menus and conducted an interview with 5 staff members and 3 residents in care.

Allegation: Staff did not meet residents’ hygiene needs. Based on observation conducted on 12-27-23, LPA observed resident2 (R2)’s hair not combed and washed appropriately. Additionally, LPA observed additional residents in care within memory care unit to contain hair not combed and clean, as well as resident facial hair not appropriately maintained on a female resident. Additionally, it was determined through interviews conducted that hygiene logs were not maintained by facility during this investigation period as evidence of completed resident hygiene needs. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. {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: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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-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: 02/16/2024

NARRATIVE

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Allegation: Staff did not provide adequate food service. LPA conducted facility observation on 1-30-24 and conducted interviews as noted above. Based on observation and interviews, it was determined that resident1 (R1) required assistance with feeding and brought to a designated area for such service. During this observation, it was revealed that R1 was at the designated location for approximately 30 minutes without food or eating assistance and exhibited spitting up as well as an incontinent episode during this wait time. Interviews conducted revealed there was no set time for when R1 would receive his food service. As a result, there is a preponderance of evidence to conclude R1 did not receive adequate food service. The preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

As a result of this investigation, citations are issued under Title 22, Division 6 and Health and Safety Codes and noted on LIC 9099D. An exit interview was conducted with Ashley Sylve 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: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/16/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/26/2024 Section Cited HSC 1569.312(a)	1 2 3 4 5 6 7	H&S Code Section 1569.312(a) Basic Service Requirements. Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will submit a plan on how residents in care will receive appropriate hygiene needs. Plan to be submitted to LPA by POC due date.
	8 9 10 11 12 13 14	Based on LPA’s observation, licensee did not ensure residents in care receive appropriate hygiene needs including hair and facial hair maintenance which posed a potential health, safety, and resident rights risk to residents in care.	8 9 10 11 12 13 14
Type B 02/26/2024 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464(f)(4) Basic Services. (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident...such as dressing, eating, bathing and assistance with taking prescribed medications…This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee will submit a plan on how residents who require eating assistance will receive service appropriately and timely, without compromising additional care needs. Plan to be submitted to LPA by POC due date.
	8 9 10 11 12 13 14	Based on observation, licensee did not ensure R1 receive adequate assistance with food service and eating assistance. This posed a potential health, safety, and resident rights risk to residents in care	8 9 10 11 12 13 14

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: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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