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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003732
Report Date: 09/10/2024
Date Signed: 09/10/2024 10:43:21 AM

Document Has Been Signed on 09/10/2024 10:43 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:
09/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Kiesha LeggsTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual inspection. LPA Valerio met with Designated Staff Kiesha Leggs, and explained the purpose of the visit. LPA was later met by Licensee Phyllis Leggs.

LPA Valerio inspected the physical plant to ensure compliance of Title 22 regulations. LPA Valerio observed common areas to be fully furnished and free from odors. Resident bedrooms were observed to have privacy as evidenced by a locked door. Residents bedrooms were fully furnished. Bathrooms were observed to be fully stocked with paper towels, toilet paper, hand soap, and a trash can. Residents were observed to have their personal supply of hygiene supplies. Kitchen was observed to be clean and appliances in working condition. The food supply met requirements of two days of perishable and seven days of non-perishable food items. An emergency supply of food was observed. The backyard was observed to have seating areas for outside visits and areas for outdoor activities. Fences were observed to have a self latching gate. Staff office was observed to be clean and free from debris. Fire extinguisher, air conditioning, and carbon monoxide detectors were observed to be in compliance and in working condition. Medications, sharps, and chemical were observed to be locked and inaccessible to residents in care.

LPA Valerio reviewed three (3) resident and two (2) staff files. Resident files were complete with required annual documentation. Staff files were complete with annual training and yearly documentation. LPA Valerio and Licensee Phyllis Leggs went over the facility Guardian Roster.

LPA Valerio requested the following annual documentation: LIC 500, LIC 308, LIC 610, and copy of Surety Bond

Per California Code of Regulations (CCR) - no deficiencies are being cited today. An exit interview was held, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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