342701122-7-8-2024-27-AS-SRIN-D7G3CW-20240723180836

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 07/08/2024
Date Signed: 07/08/2024 04:56:08 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
02/26/2024 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20240226120439

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342701122
ADMINISTRATOR:	SYLVE, ASHLEY		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 102	DATE:	07/08/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ashley Sylve		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Due to lack of supervision, residents have eloped from the facility.

INVESTIGATION FINDINGS:

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On 07/08/24, Licensing Program Analyst (LPA), Kimberly Viarella, made an unannounced visit to this facility to deliver the findings of this complaint investigation. LPA identified herself, the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). LPA met with Ashley Sylve and a brief interview followed where the DFA showed the LPA examples of updated forms for the LIC 625, the Appraisal Needs and Services Plan, as well as checklists to perform Medication Pass Audits/Observations. The DFA shared that these tools will be used to improve, tracking, communication, and training. They will also be used to assist in providing Community Care Licensing (CCL) and other agencies like hospice and home health with information upon request.

The LPA observed the following during today's visit. LPA observed 6 residents in the front activity room participating in chair exercises being let by the Activities Assistant. LPA also observed a resident in the adjacent lounge working on their computer.

Unsubstantiated

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: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

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-20240226120439

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: 07/08/2024

NARRATIVE

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LPA observed 2 maintenance workers, 2 housekeepers, and 3 carestaff. In Memory Care, this LPA observed 9 residents in the dining area, 3 of whom were playing cards with 1 care staff. LPA observed 3 residents walking the length of the Memory Care area, 2 more care staff as well as the Director of Memory Care.

Regarding the allegation: "Due to lack of supervision, residents have eloped from the facility."

This LPA reviewed incident reports in Community Care Licensing's (CCL's) electronic files for the months of December 2023, and January and February of 2024, specifically looking for reports regarding elopements. LPA obtained copies of 5 incident reports pertaining to the resident mentioned in this complaint (R1). This LPA also looked for reports for a nameless female resident mentioned in the complaint. For each of the elopement dates listed in the complaint there was a corresponding incident report which explained the circumstances surrounding R1's exiting of the building and the names of the staff members who accompanied R1.

This LPA also reviewed the staff schedule and time cards for the agency staff that was hired to assist with staffing during the time of the complaint. The LPA conducted 8 private interviews. Some of those interviewed were permanent Legacy Oaks Memory Care staff, others were staff who were no longer working at the facility, and others were agency staff hired for that time period to work in Memory Care and now work elsewhere.

All of those interviewed stated that there were no elopements during the time period of the complaint. All stated that R1 was exit seeking and had left the facility on multiple occasions, but that staff always accompanied R1 and R1 never left the building without supervision. 4 of the 8 individuals interviewed stated they had walked with R1 while attempting to redirect R1 back to Memory Care. This LPA also learned during the course of this investigation that 4 of the 8 individuals interviewed were assigned as 1-1 caregivers to R1. A 1-1 caregiver also reduced the possibility of R1 leaving the facility unsupervised.

This LPA also asked all interviewees if they had any knowledge of a female resident leaving the facility unsupervised during the time of the complaint and all said that they had not heard of any residents eloping during the time of the complaint.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20240226120439

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: 07/08/2024

NARRATIVE

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The standard for the preponderance of evidence has not been met and the department finds the allegation, "Due to a lack of supervision, residents have eloped from the facility", to be UNSUBSTANTIATED. A finding that a 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.

According to the California Code of regulations, Title 22, no deficiencies were cited or observed during today's visit. A copy of this report was provided along with APPEAL Rights.

Exit interview.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024

LIC9099 (FAS) - (06/04)

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