342701122-2-2-2024-27-AS-KHOS-D6LQQ6-20240626122141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 02/01/2024
Date Signed: 02/02/2024 04:38:44 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
11/17/2023 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20231117084639

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: 102	DATE:	02/01/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ashley Sylve		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff did not timely respond to a resident's alerts while in care.

INVESTIGATION FINDINGS:

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On 02/01/2024, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to deliver the findings for this complaint investigation. LPA identified herself upon arrival and asked to speak with the Designated Facility Administrator (DFA). LPA met with Ashley Sylve and a brief interview followed.

LPA conducted a brief walkthrough of the facility and observed approximately 15 residents participating in Bingo in the activities room in Assisted Living. This LPA had toured Memory Care earlier in the day and observed residents being treated by a visiting podiatrist. The facility was not malodorous and LPA observed housekeepers vacuuming and removing trash. LPA observed MedTechs passing medications after lunch.

Based on observations and record reviews, this LPA found that staff were not responding to call alerts within the 5-7 minute time frame that was set as the expectation by the administration of this facility. During today's visit this LPA pulled the alert cord in one of the resident's (R1's) room in Assisted Living. This LPA waited 15 minutes for carestaff to investigate. When no one arrived, this LPA checked at the concierge desk to make

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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-20231117084639

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: 02/01/2024

NARRATIVE

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sure that the alert system was functioning properly. Although the alert was flashing in R1's room, it was not registering at the computer at the front desk. Staff suggested that perhaps the alert had been reset because staff arrived after the LPA left R1's room and that was why it was no longer registering at the front desk. The LPA went back to R1's room and verified that the alert was still in the pulled position and flashing. The alert was malfunctioning.

This LPA obtained the alert call log for the month of January. There were over 4,000 alerts activated for that month. This LPA selected 01/01/24 to review. There were 139 alerts activated on that day. 96 were responded to within the 5-7 minute time frame set down by the administration. An additional 16 were responded to in under 15 minutes. 10 were responded to within 15 - 25 minutes 12 were responded to between 25 and 40 minutes. These results show a marked improvement over the response times shared during the NCC meeting on 11/09/23, however the standard 5-7 minute response time set by the Licensee was not met and there was still at least 1 alert call unit in need to repair. The preponderance of evidence standard has been met, and this allegation has been SUBSTANTIATED. This deficiency is cited on the 9099D page.

A copy of this report was provided.

Exit interview.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20231117084639

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: 02/01/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/02/2024 Section Cited CCR 87303(i)(1)(B)	1 2 3 4 5 6 7	Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more ...shall have a signal system which shall: (B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff.	1 2 3 4 5 6 7	Administrator will conduct an audit on the alert call system with maintenance and will submit the results to this LPA by COB 02/02/24 at kimberly.viarella@dss.ca.gov.
	8 9 10 11 12 13 14	The facility did not ensure the above regulation was met when the alert in room 66 failed to work properly which posed(es) an immediate risk to the health, safety and personal rights of residents in caree.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC9099 (FAS) - (06/04)

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