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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200858
Report Date: 11/01/2021
Date Signed: 11/01/2021 04:12:10 PM

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 2FACILITY NUMBER:
079200858
ADMINISTRATOR:CASTRO, ROCHEFACILITY TYPE:
740
ADDRESS:1921 WHITMAN RDTELEPHONE:
(925) 849-5729
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY:6CENSUS: DATE:
11/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Roche Castro, Licensee TIME COMPLETED:
12:18 PM
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On 11/01/2021, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted a Case Management visit for the facility. Upon arrival at 10:25 am, LPA observed a for sale sign in front of the facility. When asked about the sign licensee, Roche Castro informed the LPA of the closure plans of the facility. Castro stated that clients have been given 90-day notice with a targeted closure date of January 31st 2022.

The facility currently have 5 clients. Licensee stated that 1 client is relocating on 11/01/2021 and moving to Delly's Care Home. They are working with a placement agency for the relocation of the other residents.

On October 26th 2021, Licensee issued a proper 90-day notice to all five residents and gave LPA a copy of notice. The Licensee has also confirmed that they have control of property till June 2022.

The Licensee will provide Community Care Licensing (CCLD) with all closure plan documents which is to include:

1. Letter request for closure.
2. Original License
3. Names of all five clients
4. Names of the facilities to where the each of the clients will be relocated and the facility addresses and contact information

Licensee is to submit the above documentation before closure date.

Exit interview conducted and report given.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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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