342701122-3-18-2024-27-AS-KHOS-D3JPS3-20240320113339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 03/18/2024
Date Signed: 03/18/2024 11:28:00 AM

Unfounded

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
12/20/2023 and conducted by Evaluator Arvin Villanueva

COMPLAINT CONTROL NUMBER: 27-AS-20231220142539

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:	03/18/2024
		UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Ashley Sylve, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff did not allow resident's family member visitation.

INVESTIGATION FINDINGS:

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On 3/18/2024, at 10:15am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to continue a complaint investigation and deliver the finding regarding the allegations noted above. LPA met with Ashley Sylve, Executive Director (ED), and stated the purpose of this visit.

Note that this complaint was opened and initiated by LPA Kimberly Viarella on 12/20/23. During the course of this investigation, LPAs conducted facility observation, interviews and record reviews.
Based on interviews conducted, it was revealed that visitors can visit residents in care at any time during the day. Further interviews revealed that the facility door is usually locked after 8pm but if visitors want to visit residents after 8pm, they can make arrangements with the facility staff. A review of the facility visitation log further confirms that visitors are allowed to visit residents at any time as evidenced by the presence of visitors signing in and out on the log.

Con't to LIC 9099-C...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

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-20231220142539

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: 03/18/2024

NARRATIVE

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...Con't from LIC 9099

A review of Resident1 (R1) files revealed that R1 and their responsible party (F1) have filed a temporary restraining order against Visitor (V1) on 12/27/23 due to allegations against V1 that violated R1’s health and safety. An interview with ED revealed that at the request of R1’s Power of Attorney, the facility has removed V1 from R1’s contact list and that V1 is no longer welcome to visit R1 nor take R1 out of the facility for visitation.

Based on LPA’s review of the aforementioned documentation and the interviews conducted, the allegation of facility staff not allowing resident’s family member visitation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, or is without a reasonable basis.

An exit interview was conducted with Ashley Sylve, ED and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) -26-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024

LIC9099 (FAS) - (06/04)

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