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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701122
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:01:25 PM


Document Has Been Signed on 08/08/2024 04:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 SACRAMENTOFACILITY NUMBER:
342701122
ADMINISTRATOR:SYLVE, ASHLEYFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 102DATE:
08/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ashley SylveTIME COMPLETED:
04:00 PM
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On 08/08/24 Licensing Program Analyst (LPA) Kimberly Viarella was called by the Designated Facility Administrator/Executive Director (ED), Ashley Sylve, for guidance with a situation regarding a resident who brought a pit bull mix somewhere between 40 and 60 pounds into the facility as an "assistance dog" without the prior consent of the administrator and without an agreement in place with their current roommate. LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak with the ED. LPA met with Ashley Sylve and a brief interview followed.

LPA collected and reviewed the following materials:
Admission Agreement for R1
Statement written by R1 on 9/15/23 regarding that last animal that R1 brought into the facility without approval.
LIC 602 for R1

LPA met with R1 and conducted additional interviews and then both the ED and this LPA met with R1. ED explained that R1 violated their Admission Agreement when they brought the dog into the community without prior approval. The ED stated that they would be happy to assist R1 in obtaining an emotional support animal but that there was a process that needed to be followed. The ED stated that the dog needed to be returned to the shelter from where it was purchased, or the facility would have to call the animal control officer. R1 agreed to return the dog.

Shortly after this meeting, R1 returned to the office and asked for an accommodation to keep the dog. The ED and the LPA explained that R1 needed to follow the process outlined in the admission agreement and that the dog still needed to be removed from the facility. R1 left the office without comment.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly ViarellaTELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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