<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 08/21/2020
Date Signed: 09/10/2020 03:07:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:LEGEND GARDENSFACILITY NUMBER:
331800103
ADMINISTRATOR:YNDIRA LEPEFACILITY TYPE:
740
ADDRESS:73685 CATALINA WAYTELEPHONE:
(760) 773-3115
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:96CENSUS: 44DATE:
08/21/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Yndira Lepe, Executive DirectorTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
**Due to a computer malfunction, a handwritten report had to be issued. This is an exact duplicate of that handwritten report. See handwritten document in file for original signatures.**

Licensing Program Analyst (LPA) Tricia Danielson made an unannounced visit on this day at for the purpose of conducting a case management visit.



On 08/11/2020, LPA received a self reported notification from Wellness Director Annamaria Valenzuela that three (3) facility staff members reported to her they had observed physical and/or verbal abuse of several residents by Staff #1. During LPA interviews with Staff #2, Staff #3, and Staff #4, each staff reported their personal observations and interventions of physical and/or verbal abuse of Resident #1, Resident #2, and Resident #3 by Staff #1. Interviews revealed that Staff #1 was observed to push and/or shove Resident #2 onto a couch then sit on them holding their arms crossed against their chest, and on another occasion, grab Resident #2 by the face and shove them down onto a couch. Staff #1 was also observed to roughly roll Resident #3 into a wall while assisting them in changing an adult brief. This caused Resident #3 to strike their forehead against the wall. Staff #1 was also heard to use foul language directed at Resident #1 when they protested Staff #1's premature removal of a food tray. Additionally, LPA verified with Business Office Manager Pam Sanchez that Staff #1 had never been associated to the facility.

The following deficiencies were cited per Title 22, Division 6 of the California Code of Regulations.

An exit interview was conducted and a copy of this report, LIC 811- Confidential Names List and LIC 9058- Appeal Rights were provided to Executive Director Yndira Lepe.

**THIS IS AN AMENDED REPORT**
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: LEGEND GARDENS
FACILITY NUMBER: 331800103
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
09/01/2020
Section Cited

1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding...sleeping, or elimination. This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on interviews, Staff #1 was physically and/or verbally abusive to residents #2, #3, and #4. This poses an immediate health, safety, and personal rights risks to residents in care.


**This is an amended citation**
8
9
10
11
12
13
14
Type B
09/01/2020
Section Cited

1
2
3
4
5
6
7
Personnel Requirements- General
(g) prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) request a transfer of a criminal record clearance as specified in section 87355(c). This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on interview and record review, the Licensee did not ensure Staff #1 was associated to the facility prior to employment. This poses a potential health, safety, and personal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2