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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006562
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:16:59 PM

Document Has Been Signed on 10/23/2024 02:16 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LEGENDS HEALTHCAREFACILITY NUMBER:
306006562
ADMINISTRATOR/
DIRECTOR:		STICKEL, JEFFFACILITY TYPE:
772
ADDRESS:25226 DERBY CIRCLETELEPHONE:
(925) 321-7655
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 6CENSUS: 0DATE:
10/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:TJ Stefano, Program Director/Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of following up on the pre-licensing visit conducted on October 17, 2024. During the initial visit, LPA observed that the facility did not have an evacuation chair present on the premises. Water temperature was also measured in excess of the acceptable range.

During the present visit, LPA accompanied by Program Director TJ Stefano verified that an evacuation chair had been acquired and installed on the top floor of the facility. Water temperature was measured to be 115.5F in one of the upstairs bathrooms and 118F in the downstairs bathroom.

There are no further corrections required ahead of the facility becoming licensed.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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