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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003732
Report Date: 07/10/2024
Date Signed: 07/11/2024 09:49:40 AM

Document Has Been Signed on 07/11/2024 09:49 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: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: 5DATE:
07/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:LEGGS, BRADFORD TTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 7/10/24 at approximately 02:45pm Licensing Program Analysts (LPA) Kesha Lewis conducted a case management visit to the facility for the purpose of delivering an Order To Individual of Immediate Exclusion from all facilities. LPA'S Lewis met with Staff and, LPA explained the purpose of today's visit. Staff (S-1) excluded as a result on and ongoing complaint investigation.

LPA'S Lewis handed the Order to Licensee/Facility of Immediate Exclusion From Facility letter to staff and explained that staff must not come back to the facility.

LPA spoke with licensee and S1 does not work at the facility.

No citations were issued on today's date. A copy of the report was provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Kesha Lewis
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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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