342701122-12-13-2022-27-AS-KHOS-CM624M-20221215160409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 12/13/2022
Date Signed: 12/13/2022 03:59:08 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
11/16/2022 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221116124634

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342701122
ADMINISTRATOR:	ORELLO, MELISSA		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 76	DATE:	12/13/2022
		UNANNOUNCED	TIME BEGAN:	11:44 AM
MET WITH:	Alicia Duchine		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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-Insufficient staffing to meet resident needs
-Smoking area provided for residents is not safe for wheelchair access
-Wheelchair residents can not gain access through the facility door
-Staff refuse to assist resident upon request
-Staff did not inform resident's authorized person of illness

INVESTIGATION FINDINGS:

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On 12/13/22 at 11:44 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 Assistant Administrator Alicia Duchine and explained the purpose of today's visit.

Regarding the allegation of Insufficient staffing to meet resident needs, the Department found the following; based on interview it was determined that a few caregivers did call-in sick but Med-Techs were on the floor helping with caregiver duties. Med-Techs are cross trained for caregiving duties.

Regarding the allegation of Smoking area provided for residents is not safe for wheelchair access, the Department found the following; based on interview and observation, it was determined that residents are ok with the smoking area provided. There are cones blocking the unsafe area.

Report continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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-20221116124634

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: 12/13/2022

NARRATIVE

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Regarding the allegation of Wheelchair residents can not gain access through the facility door, the Department found the following; based on interview and observation, it was determined that wheelchair residents can gain access through facility door. When the door is opened the door stays open, and residents are able to get in and out.

Regarding the allegation of Staff refuse to assist resident upon request , the Department found the following; based on interview, it was determined that Resident 1 (R1) asked for help from Med-Tech. Med-Tech told R1 that she needed to put Meds up and she'll be back to assist R1.

Regarding the allegation of Staff did not inform resident's authorized person of illness, the Department found the following; based on interview, it was determined that staff did call and speak with R1's responsible party, informing the responsible party of the illness.

Based on interviews and observation, 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-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC9099 (FAS) - (06/04)

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