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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920201
Report Date: 04/23/2026
Date Signed: 04/23/2026 04:54:09 PM

Unsubstantiated


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
04/17/2026 and conducted by Evaluator Michael Hood
COMPLAINT CONTROL NUMBER: 59-AS-20260417132352
FACILITY NAME:LEGACY LANE SENIOR LIVING IIFACILITY NUMBER:
345920201
ADMINISTRATOR:GAUNAVOU, MORIAFACILITY TYPE:
740
ADDRESS:3039 WALNUT AVETELEPHONE:
(916) 664-3914
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
04/23/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Christina Allen, OverseerTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff stole a resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Overseer, Christina Allen, to deliver findings regarding the complaint allegation listed above.

During the investigation, LPA conducted interviews and toured the premises. The results of the investigation are as follows:

Relevant party reported that staff member (S1) stole resident (R1's) cell phone charger and their appointment book while they were away from the facility.

** Report continued on 9099-C **
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
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-20260417132352
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 LANE SENIOR LIVING II
FACILITY NUMBER: 345920201
VISIT DATE: 04/23/2026
NARRATIVE
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Interview with S1 indicated that they have never taken anything from R1. Interview with residents (R2, R3, and R4) indicated that they have never had their property stolen and never witnessed anyone else's property being stolen from staff. Interview with resident (R5) indicated that they have never had staff take their property. Interview with staff members (S2 & S3) indicated that they never witnessed staff take a resident's personal belongings.

LPA observed that R1's appointment book was found in R1's belongings in their room during investigation. Interview with S2 indicated that the facility will replace R1's phone charger.

Based on interviews conducted and observations, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Michael Hood
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2