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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700741
Report Date: 04/08/2024
Date Signed: 04/08/2024 04:13:46 PM

Document Has Been Signed on 04/08/2024 04:13 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LEGGS RESIDENTIAL ADULT CARE IIFACILITY NUMBER:
342700741
ADMINISTRATOR/
DIRECTOR:
LEGGS, BRADFORD TFACILITY TYPE:
735
ADDRESS:10044 TWIN CITIES ROADTELEPHONE:
(707) 332-1262
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 4DATE:
04/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Bradford LeggsTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct an annual required inspection. LPA was met by Administrator Bradford Leggs, and explained the purpose of the visit.

LPA Valerio and Administrator Bradford toured the facility to ensure compliance with Title 22 regulations. LPA Valerio inspected staff office, staff break room, staff bathroom, common areas, kitchen area, pantry area, medication room. resident bedrooms, resident bathrooms, and exterior area. LPA observed the staff areas to be clean and free from debris. Common areas were observed to have plenty of sitting and space for visitation and activities. The facility was observed to have an adequate food supply to meet Title 22 requirements and an emergency food supply. LPA observed a backup generator and canned goods located in the pantry. Residents were observed watching television, in their room, and getting a snack. Resident bedrooms were observed to be fully furnished, clean, and free from debris. Bathrooms were stocked with paper towels, toilet paper, hand soap, sanitizer, and a trash can. Hot water temperature was measured at 114.8*degrees F. The exterior area of the home had plenty of areas for games, outside visitation, and places to sit. LPA Valerio inspected the shed, which was empty and utilized for storage. Exit areas were free from obstructions. Medications, cleaning supplies, toxins, and sharps were locked an inaccessible to residents in care. The facility was observed to have a fire extinguisher, a fire pull alarm system, and heating/air condition. All of which appeared to be in working condition. Fire Extinguishers were last serviced on 09/27/2023. The last fire drill was conducted on March 12th, 2024.

LPA reviewed staff files and resident files. All files were observed to be up to date with current information.
LPA requested the following annual documentation be sent to the Regional Office: LIC 500, LIC 308, and LIC 610D, and copy of surety bond

Per California Code of Regulations (CCR) - Title 22, no deficiencies were observed. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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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