Legacy Oaks Of Sacramento is a residential care home for the elderly (RCFE) in Sacramento, Sacramento County, California — state license #342702896, licensed for 160 residents, listed as licensed in the CDSS record we retrieved August 2, 2026. It appears on the DHCS Assisted Living Waiver participant list checked August 9, 2026, so Medi-Cal may help pay for care services here. California has 46 dated inspection and complaint documents on file for this home going back to 2024, the most recent dated July 10, 2026 — published below in full, verbatim and unscored.

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Legacy Oaks Of Sacramento

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Residential care home for the elderly (RCFE) · Large community, 160 residents · Sacramento, CA · Sacramento County
LicensedWheelchairMemory careHospiceBedridden
No openings reportedBeds change hands in days ·
License #342702896, held since 2024 · read from the California state record on August 2, 2026 ·See on State Site →
1922 Morse Avenue · Sacramento, Sacramento County
Phone
(559) 313-8062
from the state licensing roster · August 2, 2026
No Google listing is on file for this home.
Website
None on file
Many small homes have no website — that says nothing about the care inside.
Contact facts come from the state roster, a county Area Agency on Aging roster, the home’s Google listing, or the operator — each labelled, never blended. Operators: add or correct yours, free →
Print tour sheet →

Wheelchair / non-ambulatoryApproved for 160 residents
Dementia / memory careVerified in record
Hospice careVerified in record
Bedridden careApproved for 32 residents

“Not on file” is not a no — approvals can be bed- or room-specific, so confirm current scope with the home on a tour. Where a number is shown it is the state’s own wording for how many residents the approval covers, not how many places are open today; where none is shown, the record simply does not state one.

Specific medical needs — insulin, oxygen, a catheter, an ostomy — aren’t in the state license record; ask the home directly. A feeding tube, tracheostomy, or advanced wound care usually needs skilled nursing →

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What the state record says, word for word
AGE GROUP 60 AND OVER. 160 NON-AMBULATORY, OF WHICH 32 MAY BE BEDRIDDEN. HOSPICE WAIVER GRANTED FOR (32).State service designation983 - RCFE / DEMENTIAthe CDSS license record, verbatim · checked August 2, 2026

“RCFE / Dementia” is the state’s designation for a home with an approved Dementia Care Plan of Operation — it’s recorded separately from the comments above, which is why the memory-care approval may not appear in that text.

Since 2024, the state has visited this home 61 times and filed 46 documents. The most recent is a facility evaluation report, dated July 10, 2026.

Most recent state visit
July 10, 2026
Occupancy at the February 25, 2026 visit
85 of 160 beds

The state's published file for this home includes 12 documents with transcribed findings, dated May 14, 2025 to February 25, 2026. 12 of the 12 carry the state's recorded outcome word: “Substantiated” (5), “Unfounded” (1), “Unsubstantiated” (6). 12 include the transcribed allegation the state investigated, word for word.

Summary composed by computer from the 12 documents below — every count derives from them, and the documents themselves are the state's records, verbatim. We never grade, score, or color a record.

What the state’s words mean
Substantiatedthe state found the allegation more likely true than notUnsubstantiatedinvestigated, but couldn’t be confirmed either way — not a finding of wrongdoingUnfoundedthe state concluded it was false or couldn’t have happenedType A citationthe most serious: an immediate health-or-safety risk, usually fixed on the spot or on a short deadlineType B citationless serious, with a deadline to fix
The last 36 months — 47 of 46 documentsFull record on the state’s site →
202623 state visits · 30 documents
Jul 10, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jul 8, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jul 8, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jun 30, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jun 26, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jun 26, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jun 26, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jun 26, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 28, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 22, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 22, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 21, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 21, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 15, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 13, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 13, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 12, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Apr 30, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Apr 29, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Apr 13, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Apr 3, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Mar 27, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Mar 24, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Mar 20, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Mar 17, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Mar 2, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Feb 27, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Feb 25, 2026Complaint investigation reportSubstantiated

Allegation investigated: Facility staff did not properly report incident Facility staff not answering communications from resident’s representative

Licensing Program Analyst LPA, Noel Wolf Petersen, arrived unanounced to the facility at 8:45pm to deliver findings of a complaint. LPA Met with administrator by phone and explained the purpose of the visit. In LPA's Interview with the past Administrator Johnathan Aguilar It was learned that there was a period of time from mid June to mid July 2025, where the facility was shortstaffed and unable to fulfil its regulatory obligations to report to ccl. Record review of the Incident Reports from June-July 2025 showed an observeance of timely reporting until 6/16/2025, and then a period where significant events were not reported to ccl until 7/9/2025. In that time there were 10+ events where a unplanned hospitalization exited the window of time when the event should have been reported to ccl, allong with many, many other types of report that should have been sent to the LPA. Administrator Aguilar provided this period of shortstaffing made it impossible to adequately inform and respond to cothe state’s words, verbatim · CDSS document, Feb 25, 2026 · control 27-AS-20250731151014
Feb 9, 2026Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Jan 14, 2026Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

202513 state visits · 16 documents
Dec 18, 2025Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Dec 9, 2025Complaint investigation reportSubstantiated

Allegation investigated: Facility is in disrepair.

On 12/09/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA met with Facility Designated Administrator (FDA), Jonathan Aguilar and explained the purpose of the visit. Current census was 78. A brief interview with FDA Aguilar was conducted. Allegation: Facility is in disrepair It was alleged that the facility is in disrepair. During the course of this investigation, LPA Pascua conducted interviews and conducted a tour of the facility. Based on the interviews conducted, facility staff acknowledged that the facility is in disrepair. Staff reported that portions of the flooring in the memory care building have lifted and were covered with furniture to conceal that the floors have not been properly repaired. Substantiatedthe state’s words, verbatim · CDSS document, Dec 9, 2025 · control 27-AS-20250925100233
Oct 23, 2025Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Oct 3, 2025Complaint investigation reportSubstantiated

Allegation investigated: Staff did not ensure that facility A/C is operable.

On 10/3/25, Licensing Program Analysts (LPAs) Cynthia Tamayo and Arvin Villanueva made an unannounced visit to this facility to close and deliver investigation findings into the above allegation. LPAs identified themselves upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). LPAs met with DFA, Ashley Sylve, and a brief meeting followed. It was alleged that staff did not ensure that facility A/C is operable. on 7/29/25 and 8/21/25, LPA Tamayo toured the facility including common areas and resident bedrooms. During the facility tours, it was observed resident rooms were between 78- 85 degrees, however, it was observed that the temperature was over 85 degrees in common areas such as the hallway near the dining room and server room on these dates, which is not within Title 22 regulations. Continued on 9099-C Substantiatedthe state’s words, verbatim · CDSS document, Oct 3, 2025 · control 27-AS-20250725171604
Oct 2, 2025Complaint investigation reportUnsubstantiated

Allegation investigated: Questionable Death

Licensing Program Analysts (LPAs) Vincent Moleski and Triel Lindstrom arrived unannounced to deliver findings on this complaint. LPA Moleski met with facility administrator Ashley Sylve and explained the purpose of the visit. LPA Moleski reviewed a death report for (R1). R1 was found unresponsive on the morning on 1/29/25. First responders declared R1 dead as of 8:30 a.m. R1 was 90 years old, and had a primary diagnosis of atrial fibrillation, diabetes, Hodgkin lymphoma, and had a history of stroke, according to their resident file. R1 was not receiving hospice care. The Community Care Licensing Division (CCLD) reviewed a death certificate for R1. R1's immediate cause of death was identified as a heart attack, with leading causes of myocardial hypotension, myocardial infarction, and coronary artery disease. [continued on 9099-C] Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 2, 2025 · control 27-AS-20250131105732
Sep 25, 2025Complaint investigation reportUnsubstantiated

Allegation investigated: Staff keep taking residents pendent away.

On 09/25/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to deliver the findings of this investigation into the above complaint. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Ashley Sylve, the Quality Assurance/Performance Improvement Director (RQAPID)/Designee. LPA met with Sylve and a brief meeting followed. LPA conducted interviews and a review of records during the course of this investigation. This LPA interviewed staff S1-S4. This LPA learned from S2, S3, and S4, that when staff would assist the resident (R1) with meals, changing, or showers, they would remove the pendent and put it on the small table in R1's room, which was out of R1's reach. They would then return the pendant to R1's neck following the activity. S2, S3, and S4 all mentioned the possibility that staff sometimes forgot to put the pendant back on R1 after they provided assistance with activities of daily living. That being said, 3 othe state’s words, verbatim · CDSS document, Sep 25, 2025 · control 27-AS-20250424084313
Sep 25, 2025Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Sep 23, 2025Complaint investigation reportUnsubstantiated

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

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. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 23, 2025 · control 27-AS-20250918124735
Sep 23, 2025Complaint investigation reportUnfounded

Allegation investigated: Facility does not ensure that water is clean and drinkable.

Licensing Program Analyst(LPA) Noel Wolf Petersen, arrived unannounced on 9/23/25 at 9:00 to conduct a complaint investigation, LPA met with the administrator Ashley Sylv and explained the purpose of the visit and the above allegation. LPA asked the facility to check in with thier local water board that services the facility about getting thier water tested for metal/inorganic compound/bactereological elements. A copy of Local water board test results should be sent to the department if they get them. As the water quality falls outside the scope of title 22 this agency has investigated the complaint. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/ or is without a reasonable basis. The LPA will cross report to sacremento water board. Appeal rights provided. Exit interview conducted, a copy of the report was read and left with the administrator. Unfoundedthe state’s words, verbatim · CDSS document, Sep 23, 2025 · control 27-AS-20250918122016
Sep 15, 2025Complaint investigation reportSubstantiated

Allegation investigated: The facility staff are not following infection control guidlines

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski met with facility administrator Ashley Sylve and explained the purpose of the visit. This investigation consisted of interviews and observation. LPA Moleski interviewed nine staff members (S1-S9) and two residents (R2-R3). In interviews, two staff members (S3-S4) said they had witnessed caregivers not adhering to proper infection control protocol. S3 said that they had seen staff neglecting to wash their hands after caring for a resident and removing their gloves. S3 said this occurs a couple times every week. S4 said they had also witnessed staff neglecting to wash their hands after caring for residents and removing their gloves. S4 said they had also seen caregivers continue to use the same pair of gloves after caring for a resident. In interviews, R2 and R3 both said they do not regularly see staff washing their hands. R2 said they also see regularly see usedthe state’s words, verbatim · CDSS document, Sep 15, 2025 · control 27-AS-20250131105732
Aug 6, 2025Complaint investigation reportSubstantiated

Allegation investigated: Room used for behavioral interventions is malodorous.

On 08/06/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator/Executive Director (ED). The ED was out of the building and there was not a Designee present so Ashley Sylve, the Quality Assurance/Performance Improvement Director (RQAPID)/Designee was called to come to the facility. Another staff member, S5, accompanied this LPA on a walkthrough of the facility while they waited for the Designee to arrive. LPA observed the following during her walkthrough. In the common room of assisted living, 2 residents were seated in front of a snack cart waiting for Bingo that was scheduled later in the morning. LPA observed water stations set up throughout the facility with cups and pitchers of ice water. LPA observed 2 housekeeping carts and staff servicing resident rooms. LPthe state’s words, verbatim · CDSS document, Aug 6, 2025 · control 27-AS-20250804095207
Jul 11, 2025Complaint investigation reportUnsubstantiated

Allegation investigated: Staff do not ensure resident has clean bedding.

On 07/11/205, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA Lee met with Resident Service Specialist Dej'ja Bracey and explained the purpose of the visit. The purpose of this visit is to deliver a complaint finding for the allegation above. The current census is 89. A brief interview was conducted with Dej'ja. It was alleged that staff do not ensure residents have clean bedding. This investigation consisted of observations, interviews with residents and facility staff as well as records review. During a facility visit on 06/19/025, LPA Lee inspected the facility’s linen room (47) and observed that it contained sufficient supply of clean linens. In addition, LPA Lee inspected 13 residents’ rooms and observed that the sheets, pillows, and blankets in each room were clean. Each of the 13 rooms also had a posted laundry and housekeeping schedule specific to the residents. Continued LIC 9099-C Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 11, 2025 · control 27-AS-20250617151648
Jun 4, 2025Complaint investigation reportUnsubstantiated

Allegation investigated: Resident's wallet was stolen while in care. Resident was treated disrespectfully by medication technicians.

On 06/04/25, Licensing Program Analyst, (LPA) Kimberly Viarella made an unannounced visit to this facility to deliver the findings of the investigation into the above allegations. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator/ED. The LPA met with Jonathan Aguilar and a brief interview followed. Regarding: "Resident's wallet was stolen while in care." The reporting party, resident (R1) alleged that another resident (R2) stole their wallet. During an interview with R1, R1 stated that R2 had stolen many things from their room including money, cologne, and lighters. R1 told this LPA that R2 was both a "thief and a liar." R1 had obtained assistance from a staff member to generate this complaint (S1). This LPA interviewed S1 for more details regarding these allegations. S1 stated that R1 had misplaced or lost track of things in the past. When R1 told S1 that their money, cologne, and lighters had been stolen,the state’s words, verbatim · CDSS document, Jun 4, 2025 · control 27-AS-20241223102628
May 27, 2025Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

May 14, 2025Complaint investigation reportUnsubstantiated

Allegation investigated: Staff did not afford resident privacy.

On 05/14/25 Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator. LPA met with Jonathan Aguliar the Designated Facility Administrator/Executive Director (ED). The reporting party alleged that a housekeeper did not identify themselves before entering their room on an unscheduled day to service their room. LPA conducted interviews of the parties involved as well as the ED. There were no witnesses in the hallways, and the resident (R1) was alone in their room. Based on the information obtained, staff did not afford resident privacy was found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there was not a preponderance of the evidence to prove that the alleged violation occthe state’s words, verbatim · CDSS document, May 14, 2025 · control 27-AS-20250512131619
May 14, 2025Complaint investigation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

20241 state visit · 1 document
Dec 11, 2024Facility evaluation reportReport on file

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Beside homes the same size
Type A citations20typical 1
Type B citations11typical 1
Substantiated complaints34typical 2
Total complaints26typical 7
State visits on file61typical 19
“Typical” is the statewide median across the 1,244 licensed larger communities (16+ beds) in the state record — larger, longer-licensed homes accumulate more visits and reports, so compare like with like. One complaint can contain several allegations. Counts cover this license since 2024.
Year-by-year trend
YearVisitsDocumentsSubstantiated2026233012025131642024110
An “unsubstantiated” complaint is not a finding of wrongdoing — it means the state investigated and could not confirm the allegation. Outcome words are the state’s own; we never grade, score, or color a record.Operate this home? Respond to or correct any document here, free. Respond or correct →

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$5,000$7,500 /mo
our estimate — Sacramento County band, market research June 2026; not this home’s quoted price
$3,500 · statewide low$9,000 · statewide high
California’s public record holds no per-home price, so we never invent one. Ask the home for its rate sheet, or
Ways families pay here
Private pay — ask what the base rate includes and what’s billed separately.SSI/SSP — California’s board-and-care payment standard is $1,626.07/mo (2026): $1,444.07 to the home, $182 stays with the resident.Medi-Cal ALW — this home is on the DHCS waiver list (checked August 9, 2026). Details →

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What dementia training does staff have, and is the area secured?
Non-ambulatory approval — whole home or specific rooms, and is a spot open?
How is medication handled and logged day to day?
What’s in the base monthly rate, and what’s billed separately?
Staff-to-resident ratio on day and night shifts?
How are medical emergencies handled after hours?

The first two come straight from this home’s record — a brochure won’t answer them.

Operate this home? This page is generated from CDSS public records — respond or correct it, free.
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Is Legacy Oaks Of Sacramento licensed?

Yes — Legacy Oaks Of Sacramento is a licensed residential care home for the elderly (RCFE) in Sacramento (Sacramento County): California license #342702896, shown as licensed in the CDSS state record checked August 2, 2026, licensed for 160 residents. State records list 46 inspection and complaint documents since 2024; the most recent, a facility evaluation report dated July 10, 2026, appears in the inspection record on this page.

Can Legacy Oaks Of Sacramento care for dementia, hospice, bedridden, or non-ambulatory residents?

From the CDSS license record, checked August 2, 2026.

The CDSS license record checked August 2, 2026 lists Legacy Oaks Of Sacramento with clearances for wheelchair / non-ambulatory, dementia / memory care, hospice care, and bedridden. Clearances describe what the license permits, not day-to-day staffing — confirm current scope and availability with the home directly on a tour.

Wheelchair / non-ambulatoryDementia / memory careHospice careBedridden

From the California state record. Some approvals are bed- or room-specific — always confirm current scope with the facility.

What the state record says, word for word
Verbatim, from the CDSS license recordAGE GROUP 60 AND OVER. 160 NON-AMBULATORY, OF WHICH 32 MAY BE BEDRIDDEN. HOSPICE WAIVER GRANTED FOR (32).

How much does Legacy Oaks Of Sacramento cost?

California's public licensing record does not include Legacy Oaks Of Sacramento's monthly price, so we never show or estimate one for a specific home. As county-level context only, assisted living in Sacramento County typically runs $5,000–$7,500/mo and small board-and-care homes $4,000–$6,500/mo (market research compiled June 2026 — ranges, not quotes; California's 2026 SSI/SSP board-and-care payment standard is $1,626.07/month, of which $1,444.07 is the room-and-board portion paid to the home). Ask the home for its own rate sheet and what the base rate includes — or use the cost section at the top of this page.

Does Legacy Oaks Of Sacramento accept Medi-Cal or the Assisted Living Waiver?

Yes — Medi-Cal can help pay for care at Legacy Oaks Of Sacramento through California's Assisted Living Waiver (ALW): the home appears on the Department of Health Care Services participant list checked August 9, 2026. The waiver pays for assisted-living care services — not room and board — for eligible Medi-Cal members, and each home takes a limited number of waiver residents, so ask the home about a current ALW opening.

Medi-Cal / ALW homes in Sacramento County →Assisted living on Medi-Cal in California →See the DHCS list →

How full it was at the last state visit

85 of 160 beds occupied (53%) when the state visited on February 25, 2026. Availability changes constantly — confirm a current opening with the home.

What do state inspections show for Legacy Oaks Of Sacramento?

Verbatim from CDSS complaint-investigation reports — the state's own words, never summarized by us. Record checked August 2, 2026.

The CDSS state record checked August 2, 2026 lists 61 state visits and 46 dated documents since 2024 for Legacy Oaks Of Sacramento; 12 complaint-investigation narratives are transcribed verbatim below. The most recent, dated February 25, 2026, records an allegation the state marked “Substantiated. Open any entry to read the state's full finding, word for word.

Most licensed homes receive some findings over 36 months; what matters is what was found and whether it was corrected. Counts here are shown compared with homes of similar size, and the state's own words appear in full below.

12 transcribed reports on file

2026

Complaint investigationAllegation reviewed · Substantiated
Allegation the state reviewedFacility staff did not properly report incident Facility staff not answering communications from resident’s representative
State's findingSubstantiatedThe state investigated and found this allegation more likely than not true.
Licensing Program Analyst LPA, Noel Wolf Petersen, arrived unanounced to the facility at 8:45pm to deliver findings of a complaint. LPA Met with administrator by phone and explained the purpose of the visit. In LPA's Interview with the past Administrator Johnathan Aguilar It was learned that there was a period of time from mid June to mid July 2025, where the facility was shortstaffed and unable to fulfil its regulatory obligations to report to ccl. Record review of the Incident Reports from June-July 2025 showed an observeance of timely reporting until 6/16/2025, and then a period where significant events were not reported to ccl until 7/9/2025. In that time there were 10+ events where a unplanned hospitalization exited the window of time when the event should have been reported to ccl, allong with many, many other types of report that should have been sent to the LPA. Administrator Aguilar provided this period of shortstaffing made it impossible to adequately inform and respond to coCDSS inspection report, February 25, 2026 · control 27-AS-20250731151014

2025

Complaint investigationAllegation reviewed · Substantiated
Allegation the state reviewedFacility is in disrepair.
State's findingSubstantiatedThe state investigated and found this allegation more likely than not true.
On 12/09/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA met with Facility Designated Administrator (FDA), Jonathan Aguilar and explained the purpose of the visit. Current census was 78. A brief interview with FDA Aguilar was conducted. Allegation: Facility is in disrepair It was alleged that the facility is in disrepair. During the course of this investigation, LPA Pascua conducted interviews and conducted a tour of the facility. Based on the interviews conducted, facility staff acknowledged that the facility is in disrepair. Staff reported that portions of the flooring in the memory care building have lifted and were covered with furniture to conceal that the floors have not been properly repaired. SubstantiatedCDSS inspection report, December 9, 2025 · control 27-AS-20250925100233
Complaint investigationAllegation reviewed · Substantiated
Allegation the state reviewedStaff did not ensure that facility A/C is operable.
State's findingSubstantiatedThe state investigated and found this allegation more likely than not true.
On 10/3/25, Licensing Program Analysts (LPAs) Cynthia Tamayo and Arvin Villanueva made an unannounced visit to this facility to close and deliver investigation findings into the above allegation. LPAs identified themselves upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). LPAs met with DFA, Ashley Sylve, and a brief meeting followed. It was alleged that staff did not ensure that facility A/C is operable. on 7/29/25 and 8/21/25, LPA Tamayo toured the facility including common areas and resident bedrooms. During the facility tours, it was observed resident rooms were between 78- 85 degrees, however, it was observed that the temperature was over 85 degrees in common areas such as the hallway near the dining room and server room on these dates, which is not within Title 22 regulations. Continued on 9099-C SubstantiatedCDSS inspection report, October 3, 2025 · control 27-AS-20250725171604
Complaint investigationAllegation reviewed · Unsubstantiated
Allegation the state reviewedQuestionable Death
State's findingUnsubstantiatedThe state investigated but could not confirm the allegation. This is not a finding of wrongdoing.
Licensing Program Analysts (LPAs) Vincent Moleski and Triel Lindstrom arrived unannounced to deliver findings on this complaint. LPA Moleski met with facility administrator Ashley Sylve and explained the purpose of the visit. LPA Moleski reviewed a death report for (R1). R1 was found unresponsive on the morning on 1/29/25. First responders declared R1 dead as of 8:30 a.m. R1 was 90 years old, and had a primary diagnosis of atrial fibrillation, diabetes, Hodgkin lymphoma, and had a history of stroke, according to their resident file. R1 was not receiving hospice care. The Community Care Licensing Division (CCLD) reviewed a death certificate for R1. R1's immediate cause of death was identified as a heart attack, with leading causes of myocardial hypotension, myocardial infarction, and coronary artery disease. [continued on 9099-C] UnsubstantiatedCDSS inspection report, October 2, 2025 · control 27-AS-20250131105732
Complaint investigationAllegation reviewed · Unsubstantiated
Allegation the state reviewedStaff keep taking residents pendent away.
State's findingUnsubstantiatedThe state investigated but could not confirm the allegation. This is not a finding of wrongdoing.
On 09/25/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to deliver the findings of this investigation into the above complaint. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Ashley Sylve, the Quality Assurance/Performance Improvement Director (RQAPID)/Designee. LPA met with Sylve and a brief meeting followed. LPA conducted interviews and a review of records during the course of this investigation. This LPA interviewed staff S1-S4. This LPA learned from S2, S3, and S4, that when staff would assist the resident (R1) with meals, changing, or showers, they would remove the pendent and put it on the small table in R1's room, which was out of R1's reach. They would then return the pendant to R1's neck following the activity. S2, S3, and S4 all mentioned the possibility that staff sometimes forgot to put the pendant back on R1 after they provided assistance with activities of daily living. That being said, 3 oCDSS inspection report, September 25, 2025 · control 27-AS-20250424084313
Complaint investigationAllegation reviewed · Unsubstantiated
Allegation the state reviewedFacility not ensuring that smokers and smoke do not block public access.
State's findingUnsubstantiatedThe state investigated but could not confirm the allegation. This is not a finding of wrongdoing.
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. UnsubstantiatedCDSS inspection report, September 23, 2025 · control 27-AS-20250918124735
Complaint investigationAllegation reviewed · Unfounded
Allegation the state reviewedFacility does not ensure that water is clean and drinkable.
State's findingUnfoundedThe state investigated and found the allegation to be false.
Licensing Program Analyst(LPA) Noel Wolf Petersen, arrived unannounced on 9/23/25 at 9:00 to conduct a complaint investigation, LPA met with the administrator Ashley Sylv and explained the purpose of the visit and the above allegation. LPA asked the facility to check in with thier local water board that services the facility about getting thier water tested for metal/inorganic compound/bactereological elements. A copy of Local water board test results should be sent to the department if they get them. As the water quality falls outside the scope of title 22 this agency has investigated the complaint. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/ or is without a reasonable basis. The LPA will cross report to sacremento water board. Appeal rights provided. Exit interview conducted, a copy of the report was read and left with the administrator. UnfoundedCDSS inspection report, September 23, 2025 · control 27-AS-20250918122016
Complaint investigationAllegation reviewed · Substantiated
Allegation the state reviewedThe facility staff are not following infection control guidlines
State's findingSubstantiatedThe state investigated and found this allegation more likely than not true.
Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski met with facility administrator Ashley Sylve and explained the purpose of the visit. This investigation consisted of interviews and observation. LPA Moleski interviewed nine staff members (S1-S9) and two residents (R2-R3). In interviews, two staff members (S3-S4) said they had witnessed caregivers not adhering to proper infection control protocol. S3 said that they had seen staff neglecting to wash their hands after caring for a resident and removing their gloves. S3 said this occurs a couple times every week. S4 said they had also witnessed staff neglecting to wash their hands after caring for residents and removing their gloves. S4 said they had also seen caregivers continue to use the same pair of gloves after caring for a resident. In interviews, R2 and R3 both said they do not regularly see staff washing their hands. R2 said they also see regularly see usedCDSS inspection report, September 15, 2025 · control 27-AS-20250131105732
Complaint investigationAllegation reviewed · Substantiated
Allegation the state reviewedRoom used for behavioral interventions is malodorous.
State's findingSubstantiatedThe state investigated and found this allegation more likely than not true.
On 08/06/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator/Executive Director (ED). The ED was out of the building and there was not a Designee present so Ashley Sylve, the Quality Assurance/Performance Improvement Director (RQAPID)/Designee was called to come to the facility. Another staff member, S5, accompanied this LPA on a walkthrough of the facility while they waited for the Designee to arrive. LPA observed the following during her walkthrough. In the common room of assisted living, 2 residents were seated in front of a snack cart waiting for Bingo that was scheduled later in the morning. LPA observed water stations set up throughout the facility with cups and pitchers of ice water. LPA observed 2 housekeeping carts and staff servicing resident rooms. LPCDSS inspection report, August 6, 2025 · control 27-AS-20250804095207
Complaint investigationAllegation reviewed · Unsubstantiated
Allegation the state reviewedStaff do not ensure resident has clean bedding.
State's findingUnsubstantiatedThe state investigated but could not confirm the allegation. This is not a finding of wrongdoing.
On 07/11/205, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA Lee met with Resident Service Specialist Dej'ja Bracey and explained the purpose of the visit. The purpose of this visit is to deliver a complaint finding for the allegation above. The current census is 89. A brief interview was conducted with Dej'ja. It was alleged that staff do not ensure residents have clean bedding. This investigation consisted of observations, interviews with residents and facility staff as well as records review. During a facility visit on 06/19/025, LPA Lee inspected the facility’s linen room (47) and observed that it contained sufficient supply of clean linens. In addition, LPA Lee inspected 13 residents’ rooms and observed that the sheets, pillows, and blankets in each room were clean. Each of the 13 rooms also had a posted laundry and housekeeping schedule specific to the residents. Continued LIC 9099-C UnsubstantiatedCDSS inspection report, July 11, 2025 · control 27-AS-20250617151648
Complaint investigationAllegation reviewed · Unsubstantiated
Allegation the state reviewedResident's wallet was stolen while in care. Resident was treated disrespectfully by medication technicians.
State's findingUnsubstantiatedThe state investigated but could not confirm the allegation. This is not a finding of wrongdoing.
On 06/04/25, Licensing Program Analyst, (LPA) Kimberly Viarella made an unannounced visit to this facility to deliver the findings of the investigation into the above allegations. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator/ED. The LPA met with Jonathan Aguilar and a brief interview followed. Regarding: "Resident's wallet was stolen while in care." The reporting party, resident (R1) alleged that another resident (R2) stole their wallet. During an interview with R1, R1 stated that R2 had stolen many things from their room including money, cologne, and lighters. R1 told this LPA that R2 was both a "thief and a liar." R1 had obtained assistance from a staff member to generate this complaint (S1). This LPA interviewed S1 for more details regarding these allegations. S1 stated that R1 had misplaced or lost track of things in the past. When R1 told S1 that their money, cologne, and lighters had been stolen,CDSS inspection report, June 4, 2025 · control 27-AS-20241223102628
Complaint investigationAllegation reviewed · Unsubstantiated
Allegation the state reviewedStaff did not afford resident privacy.
State's findingUnsubstantiatedThe state investigated but could not confirm the allegation. This is not a finding of wrongdoing.
On 05/14/25 Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open an investigation into the above allegation. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator. LPA met with Jonathan Aguliar the Designated Facility Administrator/Executive Director (ED). The reporting party alleged that a housekeeper did not identify themselves before entering their room on an unscheduled day to service their room. LPA conducted interviews of the parties involved as well as the ED. There were no witnesses in the hallways, and the resident (R1) was alone in their room. Based on the information obtained, staff did not afford resident privacy was found to be UNSUBSTANTIATED. A finding that the complaint allegation is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there was not a preponderance of the evidence to prove that the alleged violation occCDSS inspection report, May 14, 2025 · control 27-AS-20250512131619

Transcribed from CDSS complaint-investigation reports · record checked August 2, 2026.

What the state has logged

California has logged 61 state visits for this home as of August 2, 2026. These are the home's own counts, straight from that record — shown beside the statewide median for larger communities (16+ beds), computed across all 1,244 licensed homes of that size, because larger and longer-licensed homes naturally accumulate more visits and reports. They are facts, not a grade — a citation may be minor and since corrected, and an “unsubstantiated” complaint is not a finding of wrongdoing.

Type A citations
20
typical for this size: 1
Type B citations
11
typical for this size: 1
Substantiated complaints
34
typical for this size: 2
Total complaints
26
typical for this size: 7
State visits on file
61
typical for this size: 19
See the full inspection record on the state's site →
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