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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:56:27 PM

Unsubstantiated


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
12/21/2023 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20231221162058
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:MELISSA ORELLOFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 103DATE:
04/03/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ashley Sylve TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility phone is inoperable.

INVESTIGATION FINDINGS:
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On 04/03/24, Licensing Program Analyst (LPA) Kimberly Viarella, made an unannounced visit to this facility to deliver the findings for a complaint investigation. The LPA identified herself upon arrival and asked to speak with the Designated Facility Administrator (DFA). The LPA met with Ashley Sylve and a brief interview followed.

Regarding the allegation: Facility phone is inoperable.

LPA conducted interviews through which it was learned that the facility had a single incoming line which was forwarded to voicemail after the concierge left for the day. When the voicemail box was full, callers would be unable to leave a message and had no other option but to call back at a later time. Staff were not emptying the mailbox in a timely manner. This LPA also learend that if the concierge remained on the phone, no other calls could come in or be transferred. Because there was only 1 line, once a call was transferred to a manager's office, the line would remain busy until that manager ended their call.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
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 5
Control Number 27-AS-20231221162058
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: 04/03/2024
NARRATIVE
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 The phone was operable, but not efficient. The standard for the preponderance of the evidence has not been met, the department found the allegation,"Facility phone to be inoperable" to be UNSUBSTANTIATED.
A finding that the complaint is 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 did or did not occur, therefore the allegation is unsubstantiated.

To address this inefficiency, on 03/06/24, the DFA secured a new phone contract so that they facility increased the number of incoming lines to 5. If a call goes to voicemail, it is also sends an email alert to the DFA. The DFA also purchased cell phones for the MedTechs scheduled in Assisted Living (AL) and Memory Care (MC). When calls come in after the concierge leaves for the evening at 6:00 PM calls are now forwarded to these two cells phones so that staff may respond accordingly.

According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during this visit.

A copy of this report was provided along with Appeal Rights.

Exit Interview.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
12/21/2023 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20231221162058

FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:MELISSA ORELLOFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 103DATE:
04/03/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ashley Sylve TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are sleeping during shifts.
INVESTIGATION FINDINGS:
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On 04/03/24, Licensing Program Analyst (LPA) Kimberly Viarella, made an unannounced visit to this facility to complete this complaint investigation and deliver findings. The LPA identified herself upon arrival and asked to speak with the Designated Facility Administrator (DFA). The LPA met with Ashley Sylve and a brief interview followed.

The DFA shared that a resident alerted her to the fact that staff were sleeping on the overnight shift. The DFA launched an internal investigation and shared her findings with this LPA. The DFA provided this LPA with the written statements from 5 employees who admitted to having slept while on the overnight shift, or of having knowledge that someone was sleeping during their shift. The standard for the preponderance of the evidence has been met, the department found the allegation, "Staff are sleeping during shifts" to be SUBSTANTIATED. This deficiency is cited on the LIC 9099D page.

The DFA provided a verbal warning and documented it on a counseling form for the personnel files of these
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20231221162058
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: 04/03/2024
NARRATIVE
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employees. Each signed an acknowledgement of understanding. Staff will all be reviewing updated job descriptions and signing off to document their understanding that every shift is an awake shift.

No other deficiencies were observed or cited during this visit.

A copy of this report along with APPEAL Rights were provided.

Exit interview.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20231221162058
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: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/04/2024
Section Cited
HSC
1569.312(a)
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Basic Services Requirement 1569.312
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:
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The Designated Facility Administrator has already taken disciplinary action and provided this LPA with the signature sheets of the staff disciplined. This part of the deficiency has been cleared.
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Based upon interview with the Designated Facility Administrator and a review of the records provided, there were 5 staff that admitted to sleeping or knowing of another staff member who had slept during their shift. This posed poses an immediate risk to the health, safety and personal rights of resident in care.
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Staff will all be reviewing updated job descriptions and signing off to document their understanding that every shift is an awake shift. These signature sheets will be submitted to CCL at kimberly.viarella@dss.ca.gov by 04/12/24.
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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 RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5