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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200758
Report Date: 03/22/2022
Date Signed: 03/22/2022 03:32:04 PM


Document Has Been Signed on 03/22/2022 03:32 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:SENIOR LEGACY HOME 1FACILITY NUMBER:
019200758
ADMINISTRATOR:CASTRO, ROCHEFACILITY TYPE:
740
ADDRESS:993 OAK GROVE ROADTELEPHONE:
(925) 719-9351
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: 0DATE:
03/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:17 PM
MET WITH:Roche Castro, AdministratorTIME COMPLETED:
03:50 PM
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On 03/22/22 at 3:17PM, Licensing Program Analyst (LPA) met with administrator who stated that RCFE facility Senior Legacy Home 1 has been closed since 09/2019. The facility closure was communicated to CCLD on 09/2019 (see 812s regarding facility closure).

Administrator stated this facility was finally sold on 02/2022. LPA advised administrator to mail original license to CCLD and annual fees will be vacated as discussed with LPM J Fong on 03/22/22.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 622-2621
LICENSING EVALUATOR NAME: Daisy PanlilioTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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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