342702896-7-2-2026-27-AS-SRIN-DWPTT6-20260806150013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 07/02/2026
Date Signed: 07/02/2026 04:42:45 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
03/06/2026 and conducted by Evaluator Reza Jamaly

COMPLAINT CONTROL NUMBER: 27-AS-20260306103816

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342702896
ADMINISTRATOR:	ROSALIE SULLIVAN		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS: 75	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Executive Director Donnabell Alicia		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff dropped a resident
Staff made inappropriate comments about a resident

INVESTIGATION FINDINGS:

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On 7/2/2026 at 9:00 AM, Licensing Program Analysts(LPA), Reza Jamaly arrived unannounced
to continue with the complaint investigation and deliver findings regarding the allegation noted above. LPA initially met with staff on duty and explained the purpose of the visit. The administrator, Donnabell Alicia, was notified of the visit and arrived shortly after.

Allegation: Staff dropped a resident
To investigate the allegation, LPAs conducted interviews and reviewed resident's file.
LPAs reviewed incident's reports for the month of March and February 2026 , No fall incident report documented during R record review.
LPA Jamaly contacted R1's responsible party (RP) via phone number on file, introduced self and explained the purpose of the call, RP stated that R1 passed away, when asked about the allegations, RP stated that RP don't know specifically about the incident but the facility is terrible.
Continue on LIC 9099C on Page 2...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20260306103816

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: 07/02/2026

NARRATIVE

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When asked if RP can provide more information, RP mentioned that "it's all done I don't want to talk about it anymore, I gotta go, bye bye" and hanged up the phone.
LPA Jamaly also called R1's emergency contact number on file, someone picked up the phone, LPA introduced self and explained the purpose of the call. The other side stated" you have called the wrong number".
LPA reviewed LIC 602A dated 10/29/2025. R1 is marked as ambulatory at this time with dementia diagnosis, but needs assistance to perform activities of daily living (ADLs), including: Waking, bathing, dressing/grooming, feeding , toileting and medication management. LPA reviewed R1 assessment (change of condition) dated 1/31/2026 and ambulation status changed to non-ambulatory. Based on this document R1 uses a device to ambulate and needs a 1 person assist to use the device.
LPAs also reviewed incidents report for February and March 2026, no incident of abuse reported about R1.

Allegation: Staff made inappropriate comments about a resident
LPA contacted responsible party (RP), RP was not aware of the incident, and just stated that R1 is passed away on June 15, 2026 and the facility was terrible. RP didn't wanted to continue answering LPAs additional questions.
LPA Jamaly contact 3 out 5 housekeeping staff (S1, S2, S3, S4). S1 was not aware of the incident and hasn't heard about it from others. LPA contacted S2, S2 had hard time understanding English and interview was unsuccessful. LPA interview S4 about R1's incident fall and stated that S4 was not working at that day. S4 added that R1 was refusing the medication, and was saying nasty word to medication technician during medication time. S4 added that R1 was lashing out and didn't wanted to be at the facility. When asked if any staff was treating R1 inappropriately or saying inappropriate word, S4 stated that we had a medication technician who was straight forward/blunt to R1 when refusing the medication but S4 did not witnessed staff saying inappropriate words.

Based on LPA observations, interviews conducted, and records reviewed, the preponderance of , the preponderance of evidence standard is not met, and this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator, and a copy of this report was provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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