342702896-6-26-2026-27-AS-SRIN-DWPTRY-20260806145816

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 06/26/2026
Date Signed: 06/26/2026 04:05:19 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
06/25/2026 and conducted by Evaluator Reza Jamaly

COMPLAINT CONTROL NUMBER: 27-AS-20260625141905

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342702896
ADMINISTRATOR:	DONNABELL GALICIA		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 78	DATE:	06/26/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Executive Director Donnabell Glicia		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff are not ensuring residents are bathed
Staff are not providing shower chairs for residents
Staff are not providing a clean environment for residents
Staff are not providing adequate laundry services for residents
Staff are not providing adequate incontinence care for residents
Staff are not preventing a roach infestation in the facility
Licensee is not ensuring adequate staffing to meet residents' needs

INVESTIGATION FINDINGS:

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On 6/26/2026 Licensing Program Analysts (LPAs) Reza Jamaly and Christina Valerio arrived unannounced at this facility to conduct the initial complain investigation regarding the allegations noted above. LPAs met the Executive Director (ED) Donnabell Galicia and stated the purpose of the visit. LPA Jamaly and Valerio took a tour to the Memory Care wing assisted by Memory Director Shareetika Cha.

Allegation: Staff are not ensuring residents are bathed
LPAs conducted interview, reviewed files and took tour to the facility to investigate the allegation above.
Firstly, LPAs toured to memory care wing hallway, dining room and pantry attached to the dining room, laundry room, and kitchen and checked 6 rooms out of 12 rooms and observed to be clean and sanitary.
LPA conducted attempted interview with 3 residents (R1), (R2) and observed two residents in which one of them were sleep, and (R3) to ask about above allegation, it was unsuccessful and they didn't talk or were not able to talk.
Continued on page 2 LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
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

Control Number 27-AS-20260625141905

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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Page 2.
LPA reviewed care plan/services plan of 6 residents (R1, R2, R3, R4, R5, R6) and observed that bathing assistance, housekeeping assistance, and laundry assistance is scheduled on different dates.
LPA also reviewed showering log for 6 residents (R1, R2, R3, R4, R5, R6), which were signed and dated by S1 on 6/23/2026, 6/20/2026, 6/20/2026, 6/19/2026, 6/18/2026, 6/16/2026. To confirm if the log is correct, LPA interviewed S1, S1 stated that each resident take shower two times a week unless they refuse to do.
Allegation: Staff are not providing shower chairs for residents
LPAs toured 6 residents’ bathrooms and six out of six rooms were observed to have shower chairs. Some bathrooms were observed to have boosters as well. Memory Care director Shreetika stated that boosters are provided based on the residents’ needs. LPA Jamaly interviewed S1 and S1 confirmed that residents who needs shower chair,they have in their bathrooms.
Allegation: Staff are not providing a clean environment for residents
During the facility observation and tour to the Memory Care wing, LPA toured to hallways, 3 laundry rooms, dining/activity room and pantry attached to the dining, kitchen and checked 6 out of 12 bedrooms, which all areas observed to be clean and sanitary. One housekeeper was observed to be cleaning the dining room.
Allegation: Staff are not providing adequate laundry services for residents
To investigate above allegation, LPA toured to the laundry rooms. Total there are three laundry rooms at the facility. Laundry room 1 with one washing machine for Memory Care, laundry room 2 with 1 washing machine for Assisted Living (AL) wing and one large laundry room 3 with two washing machine for both AL and Memory Care.
LPAs observed that the washing machine for memory care was non operational.
During the interview with Memory Care director Tikka, she stated that it stopped working on 6/25/2026 around 4 PM and she immediately called the technician Eizel Corpuz to fix it. Technician scheduled to fix it today 6/26/2026.
LPA also, observed the communication between memory director and Eizel regarding fixing the laundry.
Allegation: Staff are not providing adequate incontinence care for residents
Reporting Party (RP) stated that staff “ it is impossible to keep up with the incontinence care needs of residents because staff must sign out one or two packs of wipes per shift, and they cannot adequately clean each resident with this limited number of wipes, given the diarrhea outbreak."
During the tour of the facility and the room attached to the ED office, LPA observed 18 boxes of wipes and gloves of different size with other cleaning items.

Continues on LIC 9099C page 3

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
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: 2 of 4

Control Number 27-AS-20260625141905

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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LPA interviewed memory care director about hygiene items shortages, she stated that previously staff taking a box of hygiene items per day to meet the resident's needs, but items allegedly being stolen by staff and they were taking to their home, so Wipes and Goves Check Out Log is created to prevent the misuse of the items. During an interview with memory care director, she stated that they can pick as much as wipes if needed but it should be logged in log sheet.
LPA reviewed the log and observed that the log sheet is created effective 6/16/ 2026.

Allegation: Staff are not preventing roach infestation in the facility
During the tour of memory care hallways, three laundry rooms, dining room and pantry attached to the dining room, 6 out of 12 bedrooms shower, LPAs observed no roaches. Facility observed to be clean and sanitary.
LPAs reviewed Pest Control Service Reports for the month of June and observed that California Pest Control came to the facility and provided service on the following dates:
6/24/2026, 6/17/2026, 6/10/2026.

On 5/22/2026, the same allegation (Facility staff does not ensure facility is free of pests) was investigated by LPA Christina Valerio. LPA Valerio requested and obtained Pest Control Service Reports for March 2026 and April 2026. According to the licensee, the facility has a contract with California Pest Control and they come out weekly. LPA Valerio observed California Pest Control came to the facility to provide services on the following dates:
03/03/2026, 03/10/2025,03/17/2026, 03/20/2026, 03/24/2026, 03/31/2026, 04/07/2026, 04/14/2026, 04/21/2026
Allegation: Licensee is not ensuring adequate staffing to meet residents' needs
During an interview with Memory Care director Shreetika, she stated that currently there are two med tech and 6 caregivers for both memory care and assisted living wings in which one of the memory care caregivers comes from Clipboard, whenever needed. Shreetika checked that system and LPA observed that 4 caregivers from clipboard were on duty for today 6/26/2026.

Based on the observation, record review and interview with residents and staff, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. An exit interview was held and a copy of report was provided to facility.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
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)

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