342701122-12-29-2022-27-AS-KHOS-CMRUKD-20230104143858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 12/29/2022
Date Signed: 12/29/2022 03:46:26 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
12/12/2022 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20221212130316

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:	12/29/2022
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Alicia Duchine		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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-Facility staff are not ensuring that resident got fed while in care
-Facility staff have not showered resident for an extended period of time
-Facility staff have not changed resident's bed linens for an extended period of time
-Facility staff were not present at the facility to provide care and assistance to the residents

INVESTIGATION FINDINGS:

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On 12/29/22 at 2:10 PM, 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 Facility staff are not ensuring that resident got fed while in care, the Department found the following; based on interview and observation it was determined that Resident 1 (R1) was being delivered food to his/her room. Kitchen staff go around to residents rooms who don't come to the dining hall. R1 is known by all staff to stay in the room during meal times.

Regarding the allegation of Facility staff have not showered resident for an extended period of time, the Department found the following; based on interview and record review, it was determined that R1 refused numerous showers. The facility has a shower schedule for AM and for PM. AM ranges from 6am-1pm and PM 2pm-9pm. R1 was aware of both time frames. 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: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

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-20221212130316

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: 12/29/2022

NARRATIVE

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Regarding the allegation of Facility staff have not changed resident's bed linens for an extended period of time, the Department found the following; based interview and record review, it was determined that bed linens are changed during shower times. Since R1 refused showers staff were unable to change bed linens. R1 also refused to get out of bed for staff to change the bed linens.

Regarding the allegation of Facility staff were not present at the facility to provide care and assistance to the residents, the Department found the following; based on interview and record review, it was determined that there were facility staff present, but facility was short staffed.

Based on interviews and record review, 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: 12/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022

LIC9099 (FAS) - (06/04)

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