<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701220
Report Date: 02/12/2025
Date Signed: 02/12/2025 10:40:29 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/12/2025 10:40 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:LEGENDARY WAYFACILITY NUMBER:
342701220
ADMINISTRATOR/
DIRECTOR:		GREEN, ROBERT J.FACILITY TYPE:
735
ADDRESS:9273 LEGENDARY CT.TELEPHONE:
(916) 248-1991
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 4CENSUS: 0DATE:
02/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Robert Green and Angelina GreenTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/12/2025 Licensing Program Analyst (LPA) Arvin Villanueva conducted an announced annual visit. LPA met with Robert Green co-licensee, and explained the purpose of today’s visit. Facility is currently undergoing vendorization through Alta California Regional Center at this time. Facility is unoccupied at this time.

LPA evaluated the physical plant with Licensee and Administrator Areas inspected include but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas.



The facility is a one-story home located in a residential neighborhood. Facility is fire cleared to retain/admit 4 ambulatory residents. Facility has 4 resident bedrooms. Facility has 2 bathrooms for resident use. The master bedroom is used as staff room.

LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed all resident bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. LPA inspected 2 of 2 bathrooms and were observed to be equipped with slip resistant flooring and overall in good repair at this time. Hot water temperature in 1 resident bathroom was measured at 115 degrees F. Fire extinguishers were observed. Smoke and carbon monoxide detectors were observed. LPA did not observed bodies of water and fireplace.

The facility is currently not operating and is not occupied at this time, therefore, there are no resident and staff files to audit. The facility is current on annual license fees.

Per California Code of Regulations (Title 22, Division 6, Chapter 8), no deficiencies were observed during this visit. An exit interview was held, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1