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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208844
Report Date: 06/14/2022
Date Signed: 06/14/2022 12:41:34 PM


Document Has Been Signed on 06/14/2022 12:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



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: 5DATE:
06/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Liza PinonoTIME COMPLETED:
12:53 PM
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On 6/14/2022, Licensing Program Analyst (LPA) M. Medina arrived to conduct an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit and allowed entrance by Direct care staff. Administrator contacted by telephone and arrived a short time later to conduct facility inspection. The facility has one central entry and exit point through front door. LPA observed visitor log-in/screening upon entry. Facility staff observed to be wearing face coverings.

Facility tour conducted with Administrator. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Beds in the shared bedrooms were observed to be at least 6 feet apart.

Fire extinguisher present with a service date of 12/28/2021. Smoke detectors and carbon monoxide detectors present and observed operational, facility is equipped with a pull station. Water temperature measured at 111 degrees F. LPA checked residents’ locked medications and observed a 30-day supply. LPA observed a 2-day supply of perishable food and 7-day supply of non-perishable food available.

LPA requested the following documents to be submitted to Fresno CCL office no later than 6/24/22: LIC 500, LIC 610, LIC 9020, Administrator Certificate FIrst Aid card, and Infection Control plan during visit.

No deficiencies were observed. Exit interview was conducted with Administrator and a copy of report provided.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
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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