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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208844
Report Date: 06/17/2024
Date Signed: 06/17/2024 05:33:39 PM


Document Has Been Signed on 06/17/2024 05:33 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: 6DATE:
06/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Liza PinonoTIME COMPLETED:
05:45 PM
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On 6/17/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA arrived, introduced self, stated purpose of visit and allowed entrance by Direct Care Staff. Liza Pinono, Administrator contacted by telephone and arrived a short time later to conduct facility inspection with LPA.

Currently, six (6) residents in care. Resident observed to be relaxing in the living room area and having snack at start of inspection.

Facility toured with Administrator both inside and outside. Inside of facility observed to be at a comfortable temperature, sufficient lighting, clean and odor free. All common areas in facility observed to have adequate seating for all residents in care. Kitchen toured. All sharps observed to be locked and secured in kitchen drawer. Facility observed to have a 2-day supply of perishable food and a 7-day supply of non-perishable food available. Resident bedrooms toured, LPA observed bedrooms to have required accommodations for residents. Resident bathrooms toured, bathrooms equipped with grab bars, shower area observed to have non-skid mats, and shower chair. Water temperature measured at 111 degrees F.

Facility equipped with pull station. Smoke detectors and carbon monoxide detectors observed operational during inspection. Fire extinguisher present with a service date of 12/18/2023. Last fire drill conducted on 3/30/24. Staff and resident files reviewed.

Outside of facility toured, exits open free of obstruction. No hazards observed.

Exit interview conducted. No deficiencies cited during inspection.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2024
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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