345920201-6-4-2026-59-AS-LMUZ-DVHNN2-20260629103602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345920201
Report Date: 06/04/2026
Date Signed: 06/04/2026 04:26:37 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
05/21/2026 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260521081320

FACILITY NAME:	LEGACY LANE SENIOR LIVING II		FACILITY NUMBER:	345920201
ADMINISTRATOR:	DOWNER, SHANICE		FACILITY TYPE:	740
ADDRESS:	3039 WALNUT AVE		TELEPHONE:	(916) 664-3914
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 6	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Deaja Malcolm caregiver		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not provide the foods necessary for resident's special diet.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to condluede an investigation and deliver findings to a complaint received on May 21, 2026. LPA met with Deaja Malcolm, caregiver, and stated the reason for the inspection. LPA was advised care staff, Christina Allen, had just finished her shift, and there were (6) residents were present in their resident rooms. LPA observed (2) residents in the common area during part of the inspection.

During the investigation, LPA interviewed the Administrator, (2) care staff, (4) residents, including resident, (R1), who is the subject of the investigation. LPA also reviewed pertinent documenation for (R1). The results of the investigation are as follows:

(R1) moved to the facility on/around February 2025. The Pre-Appraisal and physician's report notes (R1) has some auditory and visual impairment, and requires a gluten free, dairy free, and low sugar diet.
*cont on 9099C-1..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

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 4

Control Number 59-AS-20260521081320

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: 06/04/2026

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

9099C-1.Allegation: Staff do not provide the foods necessary for resident's special diet. The allegation states staff has not purchased resident (R1) almond milk and are not serving foods (R1) can eat.

The Administrator and another care staff stated to LPA, on May 22, 2026, that (R1) follows a special diet that does not include dairy or gluten/wheat. Both of these staff stated the facility orders specific food for (R1), who also shops on their own, with one staff confirming she drives (R1) to the store. LPA observed (2) half gallons of dairy free unsweetened almond milk in the refrigerator on May 22, 2026. One of the half gallons was almost empty and was dated May 7, 2026. The second half gallon had not been opened. Staff showed LPA where (R1) keeps her food in the refrigerator/freezer, and on the shelf. LPA observed a frozen loaf of Gluten Free bread (100% whole grain) that was marked "Dairy, soy and nut free" on the packaging. Additionally, staff showed LPA where fruit and meat on hand for (R1) were located. LPA observed (2) types of dry cereal (Chex and Cheerios). Both cereal boxes were marked "gluten free". LPA observed each resident's "Special Diet" to be posted on the outside of the refrigerator.

A third staff stated on June 4, 2026 that staff has consistently followed (R1's) special diet and the "diet sheet" for all residents is posted on the refrigerator. This staff stated (R1) will typically eat fruit and cereal for breakfast, fruit, vegetables and smoked turkey for lunch, and often has fruit, chips, potato bread and burgers (without cheese) for dinner. This staff confirmed that the facility "always has" Almond Milk on hand.

LPA interviewed (3) residents. Two residents stated they will tell staff what they can't eat prior to the meal, and staff will follow that. A third resident stated there haven't been too many times when staff served something he couldn't eat, but when they did, staff will offer an alternative food. This resident stated he does not have any allergies and staff will document what they serve.

Resident (R1) stated on June 1, 2026 that staff are "now" giving them the correct foods. On June 4, 2026, the staff showed LPA food on site for (R1), including cereal, fresh fruit (bananas, cantaloupe, berries), (1) unopened half gallon of Almond Milk, (2) kinds of deli meals, spinach/lettuce, and frozen bread and frozen vegetables.

The facility was previously cited on April 22, 2026 for not following (R1's) special diet.

Based on observations made, documentation reviewed, and interviews conducted, the 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. Copy of report provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/21/2026 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20260521081320

FACILITY NAME:	LEGACY LANE SENIOR LIVING II		FACILITY NUMBER:	345920201
ADMINISTRATOR:	DOWNER, SHANICE		FACILITY TYPE:	740
ADDRESS:	3039 WALNUT AVE		TELEPHONE:	(916) 664-3914
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 6	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Deaja Malcolm caregiver		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff restricted the resident from accessing the living room.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

During the investigation, LPA interviewed the Administrator, (2) care staff, (4) residents, and reviewed pertinent documenation. The physician's report notes (R1) is non-ambulatory, uses a walker and is able to transfer independently. The Pre-Appraisal states (R1) does not require assistance with moving about the facility. The results of the investigation are as follows:

The allegation states on May 20, 2026 (3:15 pm), (R1) attempted to sit on the living room couch; however, staff did not allow (R1) to access the living room.

The Administrator stated on May 22, 2026, that while she was folding clean laundry and placing it on the office couch, (R1) asked to sit down on the couch, and she asked (R1) to wait until after all residents had picked up their clothes, but (R1) didn't want to wait. The administrator stated this happened one time and (R1) regularly sits on the office couch without being told they cannot. The administrator showed LPA a photo where (1) resident was spicking up laundry from the couch. *cont on 9099A-C-1..

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

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 4

Control Number 59-AS-20260521081320

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: 06/04/2026

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

9099A-C-1.. The Ombudsman who was present at the facility on May 22, 2026, at the same time LPA was, stated that (R1) has been sitting on the large couch in the living room when he visited the facility previously.

(3) residents stated that they have never been denied access to the living room and have never heard staff tell any other residents they cannot go in the living room. These residents stated they have regularly observed resident (R1) sit and watch television from the large couch in the living room. These residents stated they generally don't use the couch in the office, but they have never been told they cannot since the office area is a walk way from the kitchen to a resident room.

Resident (R1) stated on June 1, 2026, that the "Ombudsman made it clear to me that that the couch is an office couch, and I have no business going into the office". (R1) explained they like to sit on the couch in the office and talk to the staff while they are cooking. (R1) added that they only sit on the Ottoman in the main living room area because the couch is made for tall people.

One staff stated that (R1) likes to lay down on the ottoman. This same staff stated that residents will sit at the dining room table and on the main couch, near the front entrance. This staff stated she wasn't present on the day (R1) wanted to sit on the couch in the office and was asked to wait for a short period.

(R1) stated that no residents sit on the big sofa, but if they got a "different sofa", (R1) would sit there. (R1) confirmed that it was "just one time" that staff wouldn't allow them to sit on the couch in the office.

Based on interviews conducted, the allegation is found 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.

Exit interview. Copy of report provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4