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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 05/13/2026
Date Signed: 05/13/2026 06:28:23 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
10/13/2025 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20251013083053
FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342702896
ADMINISTRATOR:JONATHAN AGUILARFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 82DATE:
05/13/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Donnabell Galicia, Executive Director TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not distribute residents' medications as prescribed.
Staff do not respond to residents' care needs in a timely manner.
Staff do not assist resident with showering.
INVESTIGATION FINDINGS:
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On 05/13/26, Licensing Program Analyst (LPA) Kimberly Viarella and Regional Manager (RM) Stephenie Doub, made an unannounced visit to this facility to deliver the findings for the above complaint. LPA/RM identified themselves upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator/Executive Director (ED) Donnabell Galicia. LPA/RM met with the Memory Care Director, Tika Chand who escorted the pair to the model room to work. The LPA/RM conducted an audit of open complaints, and then toured the facility.

Regarding the allegation: Staff do not distribute residents' medications as prescribed.
This allegation was previously substantiated in complaint # 27-AS 20250910090018 therefore a deficiency is not being issued for this allegation.

Regarding the allegation: Staff do not respond to residents' care needs in a timely manner.
This allegation was previously substantiated in complaint # 27-AS 20250910090018 therefore a deficiency





Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
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 5
Control Number 27-AS-20251013083053
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: 05/13/2026
NARRATIVE
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is not being issued for this allegation. Regarding the allegation: Staff do not assist residents with showering.

Based on an interview with Ashley Sylve, Designee and Regional Quality Assurance Director, 4 staff (S1-S4) received disciplinary warning notices for "failure to follow company policies and procedures." Sylve stated that she wanted to ensure that residents were getting their showers, and if they refused, that it was documented appropriately as required. The standard for the preponderance of evidence has been met, the department finds the above allegation SUBSTANTIATED. This deficiency was cited on the LIC 9099D page.

According to the California Code of Regulations, Title 22 there were no other deficiencies cited during this visit. A copy of this report was provided along with APPEAL RIGHTS and an exited interview was conducted with Galicia.



SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
10/13/2025 and conducted by Evaluator Kimberly Viarella
COMPLAINT CONTROL NUMBER: 27-AS-20251013083053

FACILITY NAME:LEGACY OAKS OF SACRAMENTOFACILITY NUMBER:
342702896
ADMINISTRATOR:JONATHAN AGUILARFACILITY TYPE:
740
ADDRESS:1922 MORSE AVENUETELEPHONE:
(916) 482-7745
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:160CENSUS: 81DATE:
05/13/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Donnabell Galicia, Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not provide residents with linen.
Staff do not assist resident with obtaining medical care.
INVESTIGATION FINDINGS:
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On 05/13/26, Licensing Program Analyst (LPA) Kimberly Viarella and Regional Manager (RM) Stephenie Doub, made an unannounced visit to this facility to deliver the findings for the above complaint. LPA/RM identified themselves upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator/Executive Director (ED) Donnabell Galicia. LPA/RM met with the Memory Care Director, Tika Chand who escorted the pair to the model room to work. The LPA/RM condcuted an audit of open complaints, and then toured the facility.

Regarding the allegation, "Staff do not provide residents with linen."

On 10/23/25, LPA observed the stored linens in the laundry room as well as in room 47. LPA observed a suffcient amount to meet the needs of the resdients in care. LPA has visited this facility on multiple dates conducting investigations and case management visits: 08/06/25, 09/16/25, 09/25/25, 10/23/25, 11/05/25, 01/15/26, and 04/29/26. During none of these visits did this LPA observe a shortage of linens or items being
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
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 5
Control Number 27-AS-20251013083053
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: 05/13/2026
NARRATIVE
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substituted for linens. The standard for the preponderance of evidence was not met. The department found the allegation "Staff do not provide residents with linen," UNSUBSTANTIATED. A finding of Unsubstantiated means that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

Regarding: Staff do not assist resident with obtaining medical care.

R5 was a resident receiving hospice services. Care notes on 10/01/25, 10/02/25, 10/05/25, 10/10/25 noted the swelling and discoloration of R5's toe. An antibiotic arrived on 10/07 and instructions that hospice nurses would treat the infected area twice a week. The hospice nurse was contacted on each of the above dates to come and evaluate R5. The hospice nurse, a medical professional, did not deem it necessary to send R5 to the hospital for evaluation. On 10/10/25, hospice was notified that the toe itself "was not completely attached" and a nurse came out to evaluate the resident. On 10/13/25 R5 "was transported to the hospital due to the discoloration of their toe which appeared to be black." R5 returned on 10/13/25 with no new orders or services. The standard for the preponderance of evidence was not met. The facility did contact the appropriate medical professional in a timely fashion. The department found the above allegation UNSUBSTANTIATED. A finding of Unsubstantiated means that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

According to the California Code of Regulations, Title 22, no other deficiencies were cited during today's visit. A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted.



SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20251013083053
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: 05/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/01/2026
Section Cited
HSC
1569.2(c)
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(c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living.... or personal care.
This requirememt was not met as evidenced by:

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ED stated they created a new shower schedule and will be rotating staff to ensure that all staff are appropriately trained.
ED will provide shower schedule and training documents signed by those who have completed it by the close of business on June 1, 2026.
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Based on a review of records, 4/4 staff were not following company policies regarding showers. This posed a potential threat the health. safety, and personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Kimberly Viarella
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5