342701122-4-16-2024-27-AS-SRIN-D7VPCG-20240806111154

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701122
Report Date: 04/16/2024
Date Signed: 04/16/2024 06:01:15 PM

Substantiated

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
04/05/2024 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20240405152635

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:	04/16/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ashley Sylve		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Facility did not allow resident to return after being discharged from the hospital.

INVESTIGATION FINDINGS:

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On 04/16/24, Licensing Program Analyst (LPA) Kimberly Viarella and Licensing Program Manager (LPM) Stephen Richardson, made an unannounced visit to this facility to deliver the findings of this complaint investigation. LPA/M identified themselves upon arrival, stated the purpose of their visit and asked to meet with the Designated Facility Administrator (DFA). LPA/M met with Ashley Sylve briefly and then the
LPA/M conducted a walkthrough of the facility. LPA/M observed 5 residents in dining room finishing up dinner, 2 MedTechs administering medications and 2 residents in the main activities area.

During an interview with the LPA/M, the DFA stated that on 3/29/24, resident (R1) was transported by Alpha One Emergency Services to the hospital due to exhibiting physically aggressive behaviors towards 4 different residents. The DFA stated that the R1 had exhibited these behaviors before and had been sent out for evaluation, and was often returned the same day. The DFA went on to state that since the agitation and aggressive behaviors kept reoccurring, the facility asked the hospital to keep R1 for observation to ensure stabilization. The hospital did so but when they tried to arrange for R1's discharge and return to the

Substantiated

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: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

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-20240405152635

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: 04/16/2024

NARRATIVE

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facility's memory care, the facility refused to allow the resident to return to home.

The DFA told the LPA/M that she refused to allow R1 back into the community because she feared for the health and safety of the other residents. The DFA went on to describe the steps she had taken to assist in finding R1 a new placement.

Based on a review of records, and the interview with the DFA, the Department determined that the refusal to allow R1 to return to the community was an unlawful eviction and the allegation: "Facility did not allow resident to return after being discharged from the hospital"has been SUBSTANTIATED. Even though a 30-day eviction was in process, R1 still had the right to return to the community after being discharged from the hospital. According to the California Code of regulations, Title 22, Chapter 8, this deficiency is cited on the LIC 9099D page.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20240405152635

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: 04/16/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/17/2024 Section Cited CCR 87724(b)	1 2 3 4 5 6 7	Eviction Procedures 87724 (b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit... The Licensee did not comply with above regulation as evidenced by:	1 2 3 4 5 6 7	The Designated Facility Administrator stated she was going to facilitate a training on Title 22 and Health and Safe and Safety Code pertaining to evictions. This will be conducted with all management staff and signature sheets will be submitted to CCL at kimberly.viarella@dss.ca.gov.
	8 9 10 11 12 13 14	Based on a review of records, and the interview with the Designated Facility Administrator, the Licensee did not allow R1 to return to the facility when the hospital was ready to discharge him and R1 was not provided with a 3-Day notice to evict. This posed(es) an immediate risk to the health, safety, and personal rights of residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Kimberly Viarella	TELEPHONE: (916) 809-5764
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC9099 (FAS) - (06/04)

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