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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920063
Report Date: 02/19/2025
Date Signed: 02/19/2025 03:51:22 PM

Document Has Been Signed on 02/19/2025 03:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LEGACY SENIOR CAREFACILITY NUMBER:
345920063
ADMINISTRATOR/
DIRECTOR:		TUILOMA, ADI LINAFACILITY TYPE:
740
ADDRESS:7084 CANEVALLEY CIRTELEPHONE:
(916) 701-7737
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 6CENSUS: 6DATE:
02/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Licensee, Lina TuilomaTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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A case management visit was conducted at this facility today. Licesning Program Analyst (LPA) Cheyenne Ratajcak and Licesning Program Manager (LPM) Laura Munoz met with Licensee/Administrator Lina Tuiloma.

During today's case management visit, LPM conducted an informal conference with the licensee at the facility.

During this meeting, the licensee was made aware that this Informal conference is a part of the Administrative Action process.

Issues discussed during this meeting were:

  1. Staffing concerns
  2. Administrator qualifications
  3. Recent deficiencies
  4. Facility records
  5. Reporting requirements
To support the facility maintaining substantial compliance with Health and Safety Statute and Title 22 regulations, the department has issued citations.

The licensee has been notified the department will provide additional case management visits as well as complete a referral to TSP (Technical Support Program) for the licensee.
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An exit interview was conducted with administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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