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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700741
Report Date: 09/15/2021
Date Signed: 09/16/2021 07:26:07 AM

Document Has Been Signed on 09/16/2021 07:26 AM - 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LEGGS RESIDENTIAL ADULT CARE IIFACILITY NUMBER:
342700741
ADMINISTRATOR:LEGGS, BRADFORD TFACILITY TYPE:
735
ADDRESS:10044 TWIN CITIES ROADTELEPHONE:
(707) 332-1262
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 0DATE:
09/15/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Brad & Phyllis Leggs, AdministratorsTIME COMPLETED:
03:15 PM
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On 09/15/21 at 2:10 PM LPA Bruce Jacobs arrived at this facility unannounced to conduct a Plan of Correction visit. LPA was met by Administrators Brad and Phyllis Leggs LPA was screened upon entry for COVID precautions. LPA explained the purpose of the visit and Brad and Phyllis Leggs accompanied LPA on facility tour

LPA Jacobs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry area, living area and other common areas, as well as outside of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with no clients at this time. The Facility is awaiting vendorization from Alta Region Center.

LPA observed areas of the physical plant that have been addressed prior to accepting residents. There were several mini-blinds that were replaced. Locks were installed for chemicals and medication storage. There were cracks on the front porch that were repaired and covered with carpet/astro turf. There was debris and clutter in the back yard that was cleared. There were two inflatable pools in the back yard that were removed. The home was cleaned and de-cluttered.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Mrs. Leggs and POC will be cleared and letter stating the same to be provided to the facility.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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