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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347003732
Report Date: 05/10/2022
Date Signed: 05/10/2022 04:30:52 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
03/28/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220328131757
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: 4DATE:
05/10/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Phyllis LeggsTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff attacked resident.
Staff yelled at resident.
Staff do not treat resident with dignity.
INVESTIGATION FINDINGS:
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On 5/10/22 Licensing Program Analyst (LPA) Maja Jensen conducted an unannounced visit. LPA Jensen met with Administrator Phyllis Leggs and explained the purpose of today's visit.

On 5/10/22 LPA Jensen conducted an interview with Administrator Phyllis Leggs, a staff member (S1), staff member (S2) and a resident (R1). During the course of the investigation LPA Jesen also reviewed staff files, medical records and the police report.

1. Based on interviews, a review of the police report, a review of staff training records and a review of medical records, it was determined that there was a physical altercation on 4/2/22 to which the police responded and removed a resident from care as they posed a threat to staff members. LPA Jensen determined there was insufficient evidence to support the allegation that staff attacked a resident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20220328131757
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: 05/10/2022
NARRATIVE
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2. Based on LPA's observation of the interaction between staff and residents during the course of two visits and based on interviews with 4 residents, 4 staff members and 3 complainant contacts it was determined that there is insufficient evidence to support the allegation of staff yelling at residents. LPA Jensen also observed that there is at least one staff member that has a normal speaking voice which could be readily misconstrued as relatively loud.

3. Based on interviews with 4 residents, 4 staff members and 3 complainant contacts it was determined that there is insufficient evidence to support the allegation of staff not treating residents with dignity.

Although the allegations may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2