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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200858
Report Date: 03/22/2022
Date Signed: 03/22/2022 03:31:22 PM

Document Has Been Signed on 03/22/2022 03:31 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 2FACILITY NUMBER:
079200858
ADMINISTRATOR:CASTRO, ROCHEFACILITY TYPE:
740
ADDRESS:1921 WHITMAN RDTELEPHONE:
(925) 849-5729
CITY:CONCORDSTATE: CAZIP CODE:
94518
CAPACITY: 6CENSUS: 0DATE:
03/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Roche Castro, AdministratorTIME COMPLETED:
03:55 PM
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On 03/22/22 at 3:25PM, Licensing Program Analyst (LPA) met with administrator who stated that RCFE facility Senior Legacy Home 2 has been closed since 12/30/21. The facility closure was communicated to CCLD in December 2021 (see 812s regarding facility closure).

Administrator stated this facility was finally sold on 03/2022. LPA advised administrator to mail original license to CCLD and facility closures for Senior Legacy Home 1 and 2 will be processed as discussed.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
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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