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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003732
Report Date: 04/06/2022
Date Signed: 04/06/2022 03:37:26 PM

Document Has Been Signed on 04/06/2022 03:37 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:LEGGS ADULT RESIDENTIAL CARE FACILITYFACILITY NUMBER:
347003732
ADMINISTRATOR:LEGGS, BRADFORDFACILITY TYPE:
735
ADDRESS:751 MOOSE CREEK WAYTELEPHONE:
(209) 745-3980
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 6DATE:
04/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Bradford LeggsTIME COMPLETED:
03:45 PM
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On 4/6/22 Licensing Program Analysts Maja Jensen and Bruce Jacobs arrived at the facility unannounced to conduct a case management visit.

LPAs reviewed incident report and discussed with Administrator the occurrence regarding resident 1 (R1) and the physical altercation on 4/2/22.

LPA's reviewed R1's file, personnel file for staff 1 (S1) and conducted interviews with R1, S1 and resident 2 (R2). See LIC 811 for Confidential Names.

LPAs also discussed an eviction notice for R1 and LPAs gave Administrator a copy of eviction procedures.

No deficiencies were cited on today's visit.

An exit interview was conducted with Administrator Bradford Leggs and a copy of the reports were left at the facility.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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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