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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 03/12/2021
Date Signed: 03/12/2021 02:28:22 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:PENDINGFACILITY TYPE:
740
ADDRESS:73685 CATALINA WAYTELEPHONE:
(760) 773-3115
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:96CENSUS: 37DATE:
03/12/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Carrie MacDonald-Community Relations DirectorTIME COMPLETED:
02:43 PM
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Licensing Program Analyst (LPA) Jennifer Semin made an unannounced visit to conduct a health and safety check. LPA met with Community Relations Director, Carrie Mac Donald and toured the facility inside and out, interviewed staff, and requested copies of pertinent documents.
LPA Semin and Ms. MacDonald toured the facility inside and out and did not observe any immediate health and safety concerns during the tour.
LPA spoke to Licensee Mark Hellickson via telephone and discussed Health and Safety (H & S) code 1569.686 Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception.
A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event; as listed in the H & S code.
A licensee who fails to comply with this section may be liable for civil penalties in an amount not to exceed one hundred dollars ($100) for each day of the failure to provide notification required in this section.
LPA and Mr. Hellickson discussed the information in PIN 19-12-ASC regarding adding or changing a management company to an existing residential care facility for the elderly license.
LPA obtained copies of pertinent documents and provided Ms. MacDonald with a copy of Health and Safety code 1569.686 and a copy of PIN 19-12-ASC.
An exit interview was conducted where this report was discussed and provided to Ms. MacDonald.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer SeminTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2021
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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