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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 07/11/2025
Date Signed: 07/11/2025 02:45:59 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
06/17/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250617151648
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342702896
ADMINISTRATOR:JONATHAN AGUILARFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(559) 313-8062
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 89DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Dej'ja Bracey TIME COMPLETED:
02:48 PM
ALLEGATION(S):
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Staff do not ensure resident has clean bedding.
INVESTIGATION FINDINGS:
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On 07/11/205, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA Lee met with Resident Service Specialist Dej'ja Bracey and explained the purpose of the visit. The purpose of this visit is to deliver a complaint finding for the allegation above. The current census is 89. A brief interview was conducted with Dej'ja.

It was alleged that staff do not ensure residents have clean bedding. This investigation consisted of observations, interviews with residents and facility staff as well as records review. During a facility visit on 06/19/025, LPA Lee inspected the facility’s linen room (47) and observed that it contained sufficient supply of clean linens. In addition, LPA Lee inspected 13 residents’ rooms and observed that the sheets, pillows, and blankets in each room were clean. Each of the 13 rooms also had a posted laundry and housekeeping schedule specific to the residents.

Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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-20250617151648
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: 07/11/2025
NARRATIVE
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During today’s visit, LPA Lee inspected an additional 7 residents’ rooms and observed that the residents’ bedding was not dirty. Interviews with 11 residents revealed that 9 residents had no concerns about the cleanliness of their bedding and stated that their bedding is changed at least once a week. Interviews with 3 facility staff members indicated that residents’ bedding are changed one to two times weekly coinciding with their shower schedule and as needed. Record reviews confirmed that bedding changes occurred with residents’ showers. Based on the interviews and evidence gathered during the investigation, LPA was unable to corroborate the allegation.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report was provided to Resident Service Specialist Dej'ja at the end of this visit.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2