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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920063
Report Date: 03/30/2026
Date Signed: 03/30/2026 10:33:38 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
03/22/2026 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20260322203954
FACILITY NAME:LEGACY SENIOR CAREFACILITY NUMBER:
345920063
ADMINISTRATOR:TUILOMA, ADI LINAFACILITY TYPE:
740
ADDRESS:7084 CANEVALLEY CIRTELEPHONE:
(916) 701-7737
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 5DATE:
03/30/2026
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jokaveti Ulalea, Care staffTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff are mishandling a resident's medications
Staff do not ensure a resident is attending scheduled medical appointments
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cassandra Mikkelson arrived unannounced to open and deliver findings for the allegations listed above. LPA met with Jokaveti Ulalea,during today’s visit.

During today's inspection LPA conducted interviews, toured the facility and reviewed records pertinent to the investigation. At this time it is necessary to gather further information.

Exit interview conducted and copy of this report given to facility.
Unfounded
Estimated Days of Completion: 10
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
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 2
Control Number 59-AS-20260322203954
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: LEGACY SENIOR CARE
FACILITY NUMBER: 345920063
VISIT DATE: 03/30/2026
NARRATIVE
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Staff are mishandling a resident's medications

Interviews conducted indicated that resident is taking their medications each day. Records reviewed indicated that resident is taking medications daily as prescribed. The quantity of medications at the facility indicate that medications are being given as prescribed. Medications on hand at the facility match the physician’s orders. Therefore, the allegation staff are mishandling a resident’s medications is unfounded.

Staff do not ensure a resident is attending scheduled medical appointments

Records reviewed indicated that facility is following and scheduling appointments for residents at the facility. Facility is also assisting with transportation to and from all appointments. Records indicated that facility staff made multiple attempts to encourage resident R1 to attend their scheduled appointments on 03/18/2026 and 03/23/2026. Resident R1 refused to attend both scheduled appointments. Facility staff documented refusals and let all appropriate agencies know of refusal. Interviews indicated that different staff made attempts to redirect and encourage resident R1 to attend scheduled appointments but resident R1 refused. Facility then assisted in rescheduling Resident R1's appointment for a later date. Therefore, the allegation staff do not ensure a resident is attending scheduled medical appointments is unfounded.

Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2