342702896-6-4-2025-27-AS-SRIN-DHKVNR-20250612163534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 06/04/2025
Date Signed: 06/04/2025 05:38:52 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
12/23/2024 and conducted by Evaluator Kimberly Viarella

COMPLAINT CONTROL NUMBER: 27-AS-20241223102628

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342702896
ADMINISTRATOR:	SYLVE, ASHLEY		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(559) 313-8062
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 92	DATE:	06/04/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jonathan Aguilar		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Resident's wallet was stolen while in care.
Resident was treated disrespectfully by medication technicians.

INVESTIGATION FINDINGS:

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On 06/04/25, Licensing Program Analyst, (LPA) Kimberly Viarella made an unannounced visit to this facility to deliver the findings of the investigation into the above allegations. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator/ED. The LPA met with Jonathan Aguilar and a brief interview followed.

Regarding: "Resident's wallet was stolen while in care."

The reporting party, resident (R1) alleged that another resident (R2) stole their wallet. During an interview with R1, R1 stated that R2 had stolen many things from their room including money, cologne, and lighters. R1 told this LPA that R2 was both a "thief and a liar." R1 had obtained assistance from a staff member to generate this complaint (S1). This LPA interviewed S1 for more details regarding these allegations.
S1 stated that R1 had misplaced or lost track of things in the past. When R1 told S1 that their money, cologne, and lighters had been stolen, S1 went into their room to assist in locating the missing items. In

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

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 3

Control Number 27-AS-20241223102628

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: 342702896
	VISIT DATE: 06/04/2025

NARRATIVE

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care notes dated 12/02/24, S1 wrote, "R1 stated they had a lighter missing, and I found several brand new lighters as well as old ones. R1 stated that money was missing, and I found multiple one-dollar bills, twenties, and 2 tens. I gave them to R1. R1 mentioned that a bag of change was missing, and I also found that. R1 has a lot of things… and R1 doesn't always know where they are, so I believe everything could have been misplaced." S1 also told this LPA that R1 also located their missing cologne.

This LPA also learned during the course of this investigation, that R1 was independent and would utilize their mobility device to go out into the community. The device had pouches strapped to it on both sides to carry personal items. Based on interviews with S1, S5, and S7, combined with this LPA's personal observations on 01/02/25, and today, 06/04/25, R1 frequently left these side pouches opened. S1 suggested that when R1 took the bus to the mall or other places in the community, their wallet might have fallen out or someone might have taken it from the open side pouch. S1 said that on several occasions, they would remind R1 to zipper the pouches closed because S1 would notice that they were bunched up and items would be on the verge of falling out.

This LPA also reviewed incident reports pertaining to R2 and there was no previous history of, or suspicion of, theft in their background. There were also no incident reports related to behaviors. This LPA interviewed R2 who stated that they would never take anyone else's property and that they were just glad they had moved into a different room.

The Department finds the allegation, "Resident's wallet was stolen while in care," to be UNSUBSTANTIATED. A finding of unsubstantiated means although the allegation may have happened or is valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

Regarding: "Resident was treated disrespectfully by medication technicians."

R1 believed that R2 had stolen their personal belongings. When interviewed, R1 told this LPA that anyone who was friends with R2 was also a liar and a thief." S1 stated that R1 felt that staff should be loyal to R1 and if R1 was mad at R2, then staff should also be mad at R2 and not interact with R2." When R1 saw medication technicians (medtechs) administering medications to R2, R1 stated that they became afraid if the medtechs were friends with R2 "they might poison R1." R1 refused to take their medications from certain medtechs. R1 refused a total of 24 doses of prescribed medications on 12/16/24 and 12/23/24. This LPA

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20241223102628

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: 342702896
	VISIT DATE: 06/04/2025

NARRATIVE

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conducted a review of records for the 2 medtechs in question and there were no disciplinary actions, similar or related to, the above allegation in their personnel files.

LPA was provided 3 incident reports for R1. On 12/09/24 "R1 was screaming at staff and residents in the dining room. R1 was upset about something to do with their roommate." The report went on to say that R1 persisted to yell and use foul language and dismissive commentary toward anyone trying to assist them. On 2/14/24, it was reported to Community Care Licensing that R1 was verbally aggressive with other residents and facility staff. The report goes on to relay that the resident stated, "The staff is defending a thief, R2 hates white people, and they will yell at them all R1 wants. The resident threatened the staff member stating R1 would report the staff member for defending a thief and a liar."

LPA interviewed a resident council member, R3 and R3 stated that R1 was always yelling and being disruptive. R3 was present in the dining room on 12/15/24 and suggested contacting the local ombudsman for assistance with R1's behaviors.

On 12/15/24 the incident report described R1 screaming at residents and staff in the dining room. The LIC 624 quoted R1 as stating, "You keep talking to the thief who stole from me and you should be in jail, you are a Nazi like the rest of them and telling everyone not to trust them."

The Department finds the allegation, "Resident was treated disrespectfully by medication technicians." to be UNSUBSTANTIATED. A finding of unsubstantiated means although the allegation may have happened or is valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit. A copy of this report was provided along with APPEAL RIGHTS.

Exit interview.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025

LIC9099 (FAS) - (06/04)

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