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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208844
Report Date: 06/27/2023
Date Signed: 06/27/2023 11:19:04 AM


Document Has Been Signed on 06/27/2023 11:19 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
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: 6DATE:
06/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Liza Pinono, TIME COMPLETED:
11:31 AM
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On 6/27/23, Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Random inspection. LPA Medina was allowed entrance by Licensee Liza Pinono.
Currently, six (6) residents in care. All residents were present at time of inspection.

Facility tour began in resident bedrooms. Rooms observed to have all required accommodations. All areas of the facility have sufficient lighting. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Hot water tested in both bathrooms with a water temperature of 110 degrees F. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed adequate food supply for the residents in care. Medications observed to be locked and secured. Medication observed to be administered as prescribed.

Smoke Alarms and carbon monoxide detectors observed to be operational at time of visit. Fire extinguisher has a service date of 12/20/22. Last fire drill conducted on 06/08/23 according to facility records. All cleaning supplies observed to be locked in secured in laundry room. All facility staff who require caregiver background checks have received criminal record index clearance or exemptions. Staff files reviewed

Outside areas toured. All exits open freely and observed to be free of obstruction. No hazards observed.

No deficiencies cited during visit. A copy of report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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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