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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208844
Report Date: 11/18/2021
Date Signed: 11/18/2021 02:08:59 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/12/2021 and conducted by Evaluator Darius Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20211012164025
FACILITY NAME:LEGENDS RESIDENTIAL CAREFACILITY NUMBER:
157208844
ADMINISTRATOR:PINONO, LIZAFACILITY TYPE:
740
ADDRESS:9402 KINGSMILL LANETELEPHONE:
(661) 829-6222
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
11/18/2021
UNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Administrator, Liza PinonoTIME COMPLETED:
02:02 PM
ALLEGATION(S):
1
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9
Facility is retaining a resident requiring a higher level of care.
INVESTIGATION FINDINGS:
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5
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11
12
13
Licensing Program Analyst (LPA) Darius Williams conducted an unannounced follow up complaint visit to deliver findings. LPA Williams met with Administrator, Liza Pinono and discussed the purpose of the visit.

LPA Williams has conducted interviews, observations, and record reviews.

According to Resident 1's physician report, dated 5/3/2021, there are no prohibited health conditions identified.

On 10/21/2021, LPA Williams observed R1 communicate verbally with staff, stand up from chair on their own, walk with and without assistance, and use their hands to manipulate items.

Also, On 10/28/2021, LPA Williams spoke with the Reporting Party (RP) and they reported having no intent to file a complaint with CCLD.

*Continued on LIC 9099C*
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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 24-AS-20211012164025
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: LEGENDS RESIDENTIAL CARE
FACILITY NUMBER: 157208844
VISIT DATE: 11/18/2021
NARRATIVE
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This agency has investigated the complaint alleging facility is retaining a resident requiring a higher level of care. We have found that the complaint was UNFOUNDED, which means the allegation could not have happened, and/or is without a reasonable basis, therefore we have dismissed the complaint.

An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2