347003732-8-23-2021-27-AS-KHOS-C6EJGT-20210831070250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003732
Report Date: 08/23/2021
Date Signed: 08/23/2021 02:14:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/06/2021 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20210806145830

FACILITY NAME:	LEGGS ADULT RESIDENTIAL CARE FACILITY		FACILITY NUMBER:	347003732
ADMINISTRATOR:	LEGGS, BRADFORD		FACILITY TYPE:	735
ADDRESS:	751 MOOSE CREEK WAY		TELEPHONE:	(209) 745-3980
CITY:	GALT	STATE: CA	ZIP CODE:	95632
CAPACITY:	6	CENSUS: 5	DATE:	08/23/2021
		UNANNOUNCED	TIME BEGAN:	01:54 PM
MET WITH:	Tyree Leggs		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Facility staff slapped resident
Facility staff threw and object at resident

INVESTIGATION FINDINGS:

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On 8-23-21 at 1:58pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for complaint allegations listed above. LPA met with Tyree Leggs, lead caregiver and explained the purpose of the visit. Administrator Bradford Leggs was not present and gave permission via phone call for Tyree Leggs to receive and sign paperwork. During the course of this investigation, LPA reviewed facility file documentation including physician reports, resident roster, staffing roster, individual service plan (IPP), and police report. LPA also conducted interviews for Resident1 (R1), R2, and R3 on 8/10/21. LPA conducted additional interviews with Staff1 (S1), S2 on 8/10/21, and S3 on 8/16/21. LPA also conducted interviews with resident case worker on 8/12/21 and 8/23/21.
Based on interviews and record reviews it was revealed that a confrontation took place on 7-28-21 between facility owner (S1) and a resident during a virtual court meeting at facility. During this confrontation, based on interviews, it was revealed that resident became upset and proceeded to assault facility owner causing facility owner to drop a cup which shattered on the ground.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20210806145830

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 FACILITY	FACILITY NUMBER: 347003732
	VISIT DATE: 08/23/2021

NARRATIVE

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It was further revealed based on interviews that facility owner was struck by resident, but was able to position resident outside of office where court meeting was held.
LPA reviewed police report which revealed resident denied injuries as a result of the confrontation and was arrested for assault of S1. LPA was unsuccessful in attempting to reach resident for further information. LPA’s interviews with R1, R2, and R3, as well as S2 and S3 revealed there was no witness of S1 assaulting residents past or present. LPA’s review of resident’s IPP revealed resident’s history of arrest for drug use and domestic violence.
Based on interviews and record reviews as stated above, it is determined that the above allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged incident occurred.An exit interview was conducted with Tyree Leggs and a copy of this report was left with Tyree.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

LIC9099 (FAS) - (06/04)

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