342702896-9-23-2025-27-AS-LKIG-DMEQBG-20251013120132

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342702896
Report Date: 09/23/2025
Date Signed: 09/23/2025 01:19:31 PM

Unsubstantiated

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
09/18/2025 and conducted by Evaluator Noel Wolf Petersen

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20250918124735

FACILITY NAME:	LEGACY OAKS OF SACRAMENTO		FACILITY NUMBER:	342702896
ADMINISTRATOR:	JONATHAN AGUILAR		FACILITY TYPE:	740
ADDRESS:	1922 MORSE AVENUE		TELEPHONE:	(916) 482-7745
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	160	CENSUS:	DATE:	09/23/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ashely Sylv		TIME COMPLETED:	01:29 PM

ALLEGATION(S):

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Facility not ensuring that smokers and smoke do not block public access.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Noel Wolf Petersen, arrived unannounced on 9/23/25 at 10:00 to conduct a complaint investigation, LPA met with the administrator Ashley Sylv and explained the purpose of the visit and the above allegation.

Per the house rules and admission agreement, clients should use the designated smoking area, not display open hostility to each other, and use a formal greviance process for resident to resident issues. LPA Observed the offensive smoke a substantial(more than 100 ft) distance from the entry way, and at least 50ft any kind of open window. LPA provided guidance about resolving the conflict interally through the enforcement of house rules. Although the allegation may have happened is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Appeal rights provided, an exit interview was conducted, a copy of the report was left with the staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Noel Wolf Petersen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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