<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 12/06/2022
Date Signed: 12/06/2022 02:56:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/28/2022 and conducted by Evaluator Christopher Hopkins-Clarke
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20221128093312
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:ORELLO, MELISSAFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 73DATE:
12/06/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Melissa OrelloTIME COMPLETED:
02:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Staff did not assist resident with meal services as necessary
-Staff did not adequately manage resident's medications
-Staff did not ensure that resident received their medication(s) according to physicians instructions.
-Staff did not ensure that resident's room was clean
-Staff did not ensure that resident had clean laundry
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/6/22 at 9:30 AM, Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Hopkins met with Administrator Melissa Orello and explained the purpose of today's visit.

Regarding the allegation of Staff did not assist resident with meal services as necessary, the Department found the following; based on interview, it was determined that staff do not leave resident's food on the floor outside of their room or on the floor inside of their room. Residents food is left on the counter inside of their room or on the side table inside of their room.

Regarding the allegation of Staff did not adequately manage resident's medications, the Department found the following; based on interview, it was determined that Kaiser had not sent an updated medication order for Resident 1 (R1), therefore the facility was unable to order the medication needed for R1. The facility reached out to Omnicare to place an emergency order but R1's responsible party(RP) told them to cancel because RP had ordered from Kaiser. Report continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
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 2
Control Number 27-AS-20221128093312
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: LEGACY OAKS OF SACRAMENTO
FACILITY NUMBER: 342701122
VISIT DATE: 12/06/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation of Staff did not ensure that resident received their medication(s) according to physicians instructions, the Department found the following; based on interview, it was determined that R1's responsible party (RP) informed the facility that they would pick up R1's medication. R1's RP reached back out to the facility after Kaiser pharmacy was closed informing facility staff that R1's medication was ready for pickup. Facility staff informed RP that R1's medication would get picked up the next morning due to the pharmacy being closed.

Regarding the allegation of Staff did not ensure that resident's room was clean, the Department found the following; based on interview and record review, it was determined that R1's room was on a cleaning schedule that housekeeping followed. R1's room was cleaned every Thursday, and the bathroom was cleaned daily.

Regarding the allegation of Staff did not ensure that resident had clean laundry, the Department found the following; based on interview and record review, it was determined that R1 was on a laundry schedule. Laundry was done for R1 every Sunday. R1 still had clean clothes available prior to Sunday's as well.

Based on interviews and record review, it is determined that the preponderance of evidence standard is not met, therefore these allegations are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted. A copy of this report was left upon exit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2