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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701414
Report Date: 12/19/2025
Date Signed: 12/19/2025 12:43:37 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
11/10/2025 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251110133553
FACILITY NAME:LEGACY LANE SENIOR LIVINGFACILITY NUMBER:
342701414
ADMINISTRATOR:ISIKELI TUIKENATABUAFACILITY TYPE:
740
ADDRESS:7610 LA MANCHA WAYTELEPHONE:
(564) 200-1736
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:14CENSUS: 12DATE:
12/19/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Isikeli TuikenatabuaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Facility staff hit resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced complaint inspection with the above facility on December 19, 2025, at 12:15 PM and met with Administrator Isikeli Tuikenatabua. The purpose of the inspection is to deliver complaint findings for the above allegation.

Based on complaint investigation interviews and records reviewed, it was determined that there was not sufficient evidence to prove that a facility staff member hit resident 1 (R1). Confidential interviews were conducted with eight individuals during the period of November 13, 2025, to December 04, 2025.

continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
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 2
Control Number 27-AS-20251110133553
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 LANE SENIOR LIVING
FACILITY NUMBER: 342701414
VISIT DATE: 12/19/2025
NARRATIVE
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Three out of three staff members reported they did not hit R1. LPA Martinez interviewed five out of five residents. Three out of five residents reported that staff did not hit R1, and they have never witnessed staff members hitting residents. One out of five residents declined to be interviewed.

Based on information obtained during the investigation, R1 reported that a staff member hit them, but did not provide the name of the staff. During an interview with R1, they denied being hit by a facility staff member. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2