<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 06/30/2026
Date Signed: 06/30/2026 12:33:52 PM

Substantiated


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
03/18/2026 and conducted by Evaluator Reza Jamaly
COMPLAINT CONTROL NUMBER: 27-AS-20260318085351
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342702896
ADMINISTRATOR:ROSALIE SULLIVANFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 78DATE:
06/30/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director Donnabell AliciaTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure that resident took medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/30/2026 at 9:30 AM, Licensing Program Analysts (LPAs) Reza Jamaly and Christina Valerio conducted an unannounced visit to the facility to continue the investigation of the above allegation. Upon arrival, LPAs met with Executive Director (ED) Donnabell Galicia and explained the purpose of the visit.
During the investigation, LPAs conducted interviews, reviewed resident records, and attempted to contact the resident's Reporting Party (RP) by telephone and email.

LPAs reviewed Resident 1's (R1's) Medication Administration Record (MAR) for February, March, and April 2026. HYDROcodone-Acetaminophen 5-325 mg (Norco) was administered as 2 tablets twice daily, with staff initials documenting each administration.
LPAs then reviewed the March 2026 MAR and observed that no medication administration was documented from 3/1/2026 through 3/9/2026. Beginning 3/10/2026 through 5/21/2026, the MAR reflected administration of HYDROcodone-Acetaminophen 10-325 mg, 1 tablet twice daily, indicating a change in medication dosage.
Continues on LIC 9099C on page 2
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
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 3
Control Number 27-AS-20260318085351
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: 06/30/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
page 2

At the time of the review, the facility was unable to provide a physician's order authorizing this medication change.

LPAs requested R1's current physician's report during the investigation.

On 3/24/2026, the facility provided a LIC 602 dated 11/10/2023. Since the document was not current, LPA Jamaly requested an updated physician's report, along with any physician's orders or supporting documentation authorizing the medication change, via email on 5/21/2026 and sent follow up email on 6/29/2026 to ED Donnabel Galicia and Memory Care Director, Shareetika Chand.  As of the date of this report, the facility had not provided a physician's order or other documentation authorizing the medication change reflected on the MAR.

LPA Christina attempted to contact the Reporting Party (RP) via telephone on 3/24/2026 and on 5/21/2026 Reza Jamaly attempted again and also sent an email on 5/21/2025 requesting clarification and supporting information, however, no response was received from RP by conclusion of the investigation.

LPAs also reviewed R1's Individual Service Plan, annual appraisal dated 2/5/2025, and Admission Agreement dated 12/2/2023. These records documented that R1 required assistance with medication administration and that facility staff were responsible for assisting R1 with taking medications as prescribed.

Based on interviews, record reviews, and the facility's failure to provide documentation supporting the medication change, the Department has determined, by a preponderance of the evidence, that the allegation is SUBSTANTIATED.

A deficiency is cited under California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87465(e), Incidental Medical and Dental Care. An exit interview was held with Administrator Donnabell Galicia, and a copy of report was left at the facility. Appeal rights were provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20260318085351
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: 06/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2026
Section Cited
CCR
87465(e)
1
2
3
4
5
6
7
87465 Incidental Medical and Dential Care (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...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The licensee will provide medication training to relavent staff and will send a copy of training certificate of complation to LPA by July 1, 2026.
8
9
10
11
12
13
14
Based on the observation, interview and record review, the licensee didn't ensure that R1's medication is administered as prescribed by physician which posess an immediatel health, safety and personal risk to person in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Reza Jamaly
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3