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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 06/26/2026
Date Signed: 06/26/2026 01:30:40 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
12/08/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251208114720
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342702896
ADMINISTRATOR:JONATHAN AGUILARFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 82DATE:
06/26/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:D. GaliciaTIME COMPLETED:
10:52 AM
ALLEGATION(S):
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Staff allow residents to be left in soiled clothing for extended periods of time.
INVESTIGATION FINDINGS:
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On 6/26/2026, Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to deliver findings for this complaint investigation. LPA met with Administrator and explained the purpose of the visit.

Allegation: Staff allow residents to be left in soiled clothing for extended periods of time.
On two separate visits to the facility the call logs were reviewed and the longest response time to a call button from a resident was 12 minutes. Based on observations and records review the allegation cannot be substantiated. 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, therefore the allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
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 4
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
12/08/2025 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20251208114720

FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342702896
ADMINISTRATOR:JONATHAN AGUILARFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 82DATE:
06/26/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:D. GaliciaTIME COMPLETED:
10:52 AM
ALLEGATION(S):
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Staff do not administer resident’s medications as prescribed
INVESTIGATION FINDINGS:
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On 12/18/25 LPA reviewed an Omnicare medication audit. It was discovered that some resident’s medications were expired or not available for administration. Overall, PRN order guidelines were not followed, medications were not available, expired medications were found and there were inconsistencies with dating medication supplies. On 1/8/25, during a concurrent annual inspection and complaint visit, LPAs Kimberly Viarella and Arvin Villanueva conducted an observation of med tech on duty, passing the noon medication. At the time of the med pass observations were made at 12:24pm. Review of resident file showed that R1was prescribed a PRN to be taken every hour and it was not available. Other inconsistencies were noted and the medtech was unable to provide an explanation.

Based on observations made, interview with the med tech and audit report reviewed, this allegation is substantiated. The Department has concluded, based on the preponderance of the evidence obtained during this investigation, that the above is SUBSTANTIATED.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20251208114720
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: 06/26/2026
NARRATIVE
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The following deficiency, 87465(e) (1-4) is cited per California Code of Regulations, TITLE 22, DIVISION 6, CHAPTER 8 Article 8.

Exit interview was conducted with the licensee. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 27-AS-20251208114720
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/29/2026
Section Cited
CCR
87465(e)(1-4)
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(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information.(1) The specific symptoms which indicate the need for the use of the medication.(2)The exact dosage.(3) The minimum number of hours between doses.(4) the maximum number of doses allowed in each 24-hour period.
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Med-tech in-service training will be conducted on the POC date if additional time is need the facility will send an email to the LPA to request additional time.
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This requirement was not met as evidenced by med pass observations were made at 12:24pm. Review of resident file showed that R1 was prescribed a PRN to be taken every hour and it was not available. Other inconsistencies were noted and the medtech was unable to provide an explanation. This is an immediate risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4