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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920084
Report Date: 06/16/2026
Date Signed: 06/16/2026 02:51:00 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2026 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20260520151638
FACILITY NAME:LEGACY SENIOR CARE IIFACILITY NUMBER:
345920084
ADMINISTRATOR:TUILOMA, ADI LINAFACILITY TYPE:
740
ADDRESS:3624 OWENS WAYTELEPHONE:
(916) 999-0140
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 6DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Adilina Tuiloma, Care staffTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Licensee/staff member was under the influence of alcohol while present in the facility, impairing their ability to provide adequate care and supervision, which presents a risk to residents in care.
Staff are allowing people to enter the facility to sell residents illegal drugs.
Staff are allowing residents to consume illegal drugs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint allegations. LPA met with Adilina Tuiloma during today’s inspection.
The department investigated allegation, “Licensee/staff member was under the influence of alcohol while present in the facility, impairing their ability to provide adequate care and supervision, which presents a risk to residents in care.” The department interviewed residents and staff and toured the facility. During interviews with resident, it was determined they have not smelled alcohol on caregiver or seen staff drinking at the facility. LPA toured facility and did not observe alcohol within the facility. Due to the information gathered, the department finds allegation unfounded.
The department investigated allegation, “Staff are allowing people to enter the facility to sell residents illegal drugs.” The department interviewed residents and staff and toured the facility. During interviews with residents, it was reported they have not observed resident’s taking drugs or possessing drug paraphernalia.
Continuation on 9099-C.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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-20260520151638
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: LEGACY SENIOR CARE II
FACILITY NUMBER: 345920084
VISIT DATE: 06/16/2026
NARRATIVE
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In addition, resident has not observed individuals selling drugs to other residents. LPA toured the facility and did not observe drug paraphernalia, and no one seemed under the influence of drugs or alcohol. Due to the information gathered, the department finds allegation unfounded.
The department investigated allegation, “Staff are allowing residents to consume illegal drugs.” The department interviewed residents and staff and toured the facility. During interviews with residents, it was reported they have not observed resident’s taking drugs or possessing drug paraphernalia. LPA toured the facility and did not observe drug paraphernalia, and no one seemed under the influence of drugs or alcohol. Due to the information gathered, the department finds allegation unfounded.

The allegation is UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted and copy of report provided.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/20/2026 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20260520151638

FACILITY NAME:LEGACY SENIOR CARE IIFACILITY NUMBER:
345920084
ADMINISTRATOR:TUILOMA, ADI LINAFACILITY TYPE:
740
ADDRESS:3624 OWENS WAYTELEPHONE:
(916) 999-0140
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:6CENSUS: 6DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Adilina Tuiloma, Care staffTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Facility staff not seeking medical treatment for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint allegations. LPA met with Adilina Tuiloma during today’s inspection.
The department investigated allegation, “Facility staff not seeking medical treatment for residents”. The department interviewed residents and staff, and relevant parties. It was reported that in April 2026, R1 had a fall in the middle of the night in their room and started calling out. R2 woke up and heard the yelling and tried reporting incident to caregiver by knocking on the caregiver room. R2 reported that no one answered the knocks on the caregiver room so they called 911. Upon arrival of the fire department, caregiver did not answer the knocks from emergency personnel and so R2 had to answer the front door and let them into the facility. It was reported that the emergency personnel had to knock on the caregiver room for the caregiver to finally respond. R1 was then taken to the hospital for further treatment.

Continuation on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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-20260520151638
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: LEGACY SENIOR CARE II
FACILITY NUMBER: 345920084
VISIT DATE: 06/16/2026
NARRATIVE
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LPA spoke to a fire department representative and reviewed incident calls at the facility address. Representative stated there were no calls of service in April 2026. However, in March 2026, there was one call that occurred at 3:30 AM in which R1 fell and called 911 themselves. It was documented that when the fire department personnel arrived, R1 was accompanied by a caregiver and a housemate. Due to the information gathered, LPA finds allegation unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated.

Exit interview was conducted and copy of report provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4