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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003732
Report Date: 12/19/2022
Date Signed: 12/19/2022 02:34:17 PM

Document Has Been Signed on 12/19/2022 02:34 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 AC/SC, 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:
12/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tyree LeggsTIME COMPLETED:
03:00 PM
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On 12/19/22 Licensing Program Analysts Kesha Lewis and Albert Johnson arrived at the facility unannounced to conduct a case management visit.

LPAs reviewed facility action report. LPA'S also checked continuing education units had been completed, also checked was DSPT it was completed on 12/08/2022 (copy taken). A plan to make sure facility files were updated for CEU, DSP1, DSP2 was created (copy taken).

LPA'S toured the facility and it was in compliance. Water temperature in the bathroom it was measured at 120-degree Fahrenheit.

No deficiencies were cited on today's visit.

An exit interview was conducted and a copy of the reports were left at the facility.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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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