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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003732
Report Date: 06/04/2024
Date Signed: 06/04/2024 12:30:33 PM

Document Has Been Signed on 06/04/2024 12:30 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 ADULT RESIDENTIAL CARE FACILITYFACILITY NUMBER:
347003732
ADMINISTRATOR/
DIRECTOR:
LEGGS, BRADFORDFACILITY TYPE:
735
ADDRESS:751 MOOSE CREEK WAYTELEPHONE:
(209) 745-3980
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 6DATE:
06/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Bradford LeggsTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management visit to follow up on an incident report received by the Regional Office (RO). LPA Valerio met with Administrator Bradford Leggs, and explained the purpose of the visit.

The RO received two incident reports regarding Resident 1 (R1) and Resident 2 (R2) on 05/23/2024. R1 was physically assaulted by R2. R2 used a fork to physically hurt R1 on the right hand, back of the head, and right cheek. All wounds superficial and were cleaned with soap and water. R2 was 5150'd due to behaviors observed by Galt Police Department.

According to the administrator, the facility had taken R2 to R2's psychiatry appointment earlier in the day. The psychiatrist sent R2 to Kaiser based on what was learned but Kaiser released the resident back to the staff. Later that evening, the incident occurred with R1 and R2 after an argument occurred between the two individuals. Daily notes show that staff were checking on the residents every hour. Once the incident occurred, staff responded within seconds. Galt Police Department responded and no medical treatment was required.

According to the staff, the residents have changed roommates and have no issues currently. R2 has returned to the facility with new orders and a follow up appointment.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 1, no deficiencies are being cited.

An exit interview was held, and a copy of report was left at the facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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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