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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701615
Report Date: 07/24/2026
Date Signed: 07/24/2026 07:01:20 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
07/23/2026 and conducted by Evaluator Christina Valerio
COMPLAINT CONTROL NUMBER: 27-AS-20260723122921
FACILITY NAME:LEGACY LANE SENIOR LIVING IIIFACILITY NUMBER:
342701615
ADMINISTRATOR:GAUNAVOU, MORIAFACILITY TYPE:
740
ADDRESS:9442 MAZATLAN WAYTELEPHONE:
(564) 200-1736
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:6CENSUS: 5DATE:
07/24/2026
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Kirk CampbellTIME COMPLETED:
07:15 PM
ALLEGATION(S):
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Facility is in disrepair
Staff did not provide proper accommodations to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a complaint investigation. LPA Valerio met with facility staff Kirk Campbell, and explained the purpose of today's visit. LPA Valerio spoke to Assistant Administrator Esther Tabua via cell phone. She designated staff to sign on her behalf. At 5:30PM, Licensing Program Manager (LPM) Stephen Richardson arrived to the facility to assist LPA Valerio.

It is alleged that the facility's air conditioning has not working since mid-june. According to the Reporting Party (RP), despite ongoing complaints from residents, staff, family members, the facility has failed to make the necessary repairs or implement an effective solution to maintain a safe and comfortable living environment. Staff acknowledged that the air conditioning system was not functioning properly but were unable to provide information regarding when repairs would be completed. Residents have expressed ongoing discomfort and have reported difficulty resting, sleeping, and participating in daily activities due to the excessive heat." Continues on LIC 9099 -C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
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 3
Control Number 27-AS-20260723122921
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 III
FACILITY NUMBER: 342701615
VISIT DATE: 07/24/2026
NARRATIVE
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On June 15, 2026, LPA Reza Jamaly and LPA Arvin Villanueva observed the facility to be 86 degrees Fahrenheit. LPAs observed electric fans were being utilized during this visit. LPAs observed resident rooms to have electric fans on. The living room and kitchen area - LPAs observed electric fans being utilized. Two maintenance individuals came on June 14, 2026 and June 18, 2026. The facility bought fans for the facility.

On July 24, 2026, LPA Valerio observed the temperature outside the facility to be 92 degree Fahrenheit, with a high of 94 degree F. for the day. LPA recorded the temperature inside the facility to be measured 86 degree Fahrenheit, which is not within the regulatory range of 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. The thermastat was set to 58 degrees, but the air conditioning unit was not working. LPA Valerio took temperature recordings of resident bedrooms and hallways. The temperatures were 86, 88, and 89 degrees F. LPA Valerio took pictures for reference. According to the staff, the facility installed one window unit earlier in the day and was unaware if the other rooms would get one today. At 5:00 PM, LPA recorded the temperature to be 90 degrees Fahrenheit inside the facility. A picture reference was taken for future reference. At 6:00 PM, the temperature was record to be 90 degrees F. At 6:29 PM, the temperature in a resident's room was 92 degrees and residents were observed to take off their clothes to cool down.

LPA Valerio spoke to 3 out of 4 residents present, which stated they felt hot but had been brought ice water from the staff. LPA Valerio observed two residents in long sleeved clothing, another resident in just their briefs, and another resident in pants and a short sleeve shirt. The staff, which is a live-in care staff, appeared to be sweating and stated they got used to the temperature.

LPA Valerio attempted to contact Licensee Cleopatra Tania Gardiner; however, both calls were forwarded to voicemail. According to Assistant Administrator Esther, she did not have the contact information for alleged new administrator Shanice Downer. LPM recommended the resident's be relocated to a relocation cite but AA did not get back to LPA or LPM and stated that someone would come to the facility to bring coolers.

Based on the aforementioned information, the allegations are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260723122921
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 III
FACILITY NUMBER: 342701615
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2026
Section Cited
CCR
87303(b)(2)
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87303 Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. (2)The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C)... This requirement was not met as evidenced by:
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Licensee stated they will install window unit air conditioners in every resident room and staff room by POC due date. LPA Valerio observed a man name Isaac to bring swamp coolers at 6:30 PM. LPA informed that another one needed to be brought.
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Based on observations, the licensee did not ensure to maintain a comfortable temperature for residents in care, which poses an immediate health and safety risk to residents in care.
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After 5:00 PM ,Administrator, Assistant Administrator, and Licensee did not answer LPA or LPM call or text.
Type A
07/25/2026
Section Cited
CCR
87205(a)
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87205 Accountability of Licensee Governing Body (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility... This requirement was not met as evidenced by:
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Licensee will submit statement of acknowledgement to LPA Valerio stating the report from today's visit was reviewed. Licensee will submit a plan to increase supervision of the facility affairs by POC due date of 07/25/2026.
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Based on observations, the licensee did not ensure to have general supervision over the affairs of the facility and allowed the facility to maintain a temperature above a comfortable range, which poses an immediate health and safety risk to residents in care.
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After 5:00 PM, Administrator, Assistant Administrator, and Licensee did not answer LPA or LPM call or text.
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
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3