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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 07/10/2026
Date Signed: 07/10/2026 03:19:26 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
11/03/2025 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20251103152307
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: 75DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Donnabell Galicia, Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Questionable death
INVESTIGATION FINDINGS:
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On 07/10/2026, at 8:40 AM, Licensing Program Analyst (LPA) Kimberly Viarella made an unannouced visit to this facility to deliver the findings of this investigation. LPA identified herself, stated the purpose of the visit and asked to meet with the Designated Facility Administrator/Executive Director (ED), Donnabell Galicia. There were no members of management present. There were 2 Medication Technicians (MedTechs) working in the assisted living side, 2 Care Staff in Assisted Living and 3 Care Staff in Memory Care. When asked for access to an empty room to work in, MedTech working just off the lobby told this LPA that they did not have keys to access those rooms but that managment would be in shortly. The Director of Memory Care arrived at approximately 9:00 AM and provided this LPA with a private room to work in and the ED arrived shortly after and spoke to the LPA regarding a plan of correction submission.

Regarding the Allegation: Questionable death
The Death Certificate was obtained and indicates that the resident's (R1's) immediate cause of death as cardiac arrest and the leading causes as diabetes, hypertension, hyperlipidemia. R1's death was
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
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 5
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
11/03/2025 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20251103152307

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: 75DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Donnabell Galicia, Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
 Facility staff are not keeping accurate resident records
INVESTIGATION FINDINGS:
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On 07/10/2026, Licensing Program Analyst (LPA) Kimberly Viarella made an unannouced visit to this facility to deliver the findings of this investigation. LPA identified herself, stated the purpose of the visit and asked to meet with the Designated Facility Administrator/Executive Director (ED), Donnabell Galicia.
The two met to discuss the findings of this complaint investigation.

Allegation: Facility staff are not keeping accurate resident records

On 01/08/26 LPA conducted a review of resident records and found that 7 out of 8 resident files did not have the resident PRN authorization form. 3 out of 8 residents were missing Personal Rights forms. 1 out of 8 residents was missing their identification and emergency information form. Based on this record review of resident files, the above 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:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20251103152307
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: 07/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2026
Section Cited
CCR
87506(a)
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Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each...facility...readily available to facility staff and to licensing agency staff.
The above requirement was not met as evidenced by:
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ED stated they will complete a resident file audit. LPA to provide list of documents/information required for each resident. The audit report will be submitted to Licensing by close of business on 09/17/26 by emailing CCLASCPSacramentoSouthRO@dss.ca.gov
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Based on record review, 7/ 8 resident files did not have the resident PRN authorization form. 3/8 residents were missing Personal Rights forms. 1/8 residents was missing identification and emergency information form. This posed a potential threat to the health, safety and personal rights of 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.
SUPERVISOR'S NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 27-AS-20251103152307
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: 07/10/2026
NARRATIVE
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The following deficiency, 87506 (a) was cited per California Code of Regulations, TITLE 22, DIVISION 6, CHAPTER 8 Article 9 and may be found on the LIC 9099D page.

During her tour of the facility, LPA observed that the Medication Technician was administering morning 8:00 AM Medications at 10:00 AM in Memory Care. A case management visit will be conducted following this one to address this deficiency.

Exit interview was conducted with the ED, Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20251103152307
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: 07/10/2026
NARRATIVE
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reported to the Sacramento County coroner's office and no autopsy was performed. The death certificate does not indicate that this death was questionable in any manner. The above allegation is unsubstantiated. 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.

According to the California Code of Regulations, Title 22, no other deficiencies were cited during today's visit, a copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Galicia.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5