331800103-10-19-2021-18-AS-TDAN-C7XTVZ-20211019150447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 10/19/2021
Date Signed: 10/19/2021 03:04:52 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 GARDENS		FACILITY NUMBER:	331800103
ADMINISTRATOR:	PENDING		FACILITY TYPE:	740
ADDRESS:	73685 CATALINA WAY		TELEPHONE:	(760) 773-3115
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	96	CENSUS: 29	DATE:	10/19/2021
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Carrie MacDonald, Community Relations Director		TIME COMPLETED:	03:15 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	Licensing Program Analyst (LPA) Tricia Danielson conducted an unannounced plan of correction (POC) visit to verify corrections of citations issued during a previous visit. LPA met with Community Relations Director (CRD) Carrie MacDonald. The following deficiencies were not corrected by the POC due date nor have they been corrected at the time of this visit. Civil penalties are being assessed and will continue to accrue until correction has been submitted: Deficiency cited 9/8/2021 under California Code of Regulations Section 87205(a) - Accountability of Licensee Governing Body. POC was that the Licensee contact the facility within 24 hours to receive a status update of the affairs of the facility. The Licensee is required to submit proof that this communication was made to the facility and an update was obtained in order to clear this deficiency. Civil penalties assessed today at the rate of $100 per day. Today’s civil penalty assessment of $600 is for the period of 10/14/2021 through 10/19/2021. Civil penalties will continue to accrue at the rate of $100 per day until submission of proof of POC. To date, civil penalties for the facility's failure to clear this deficiency total $4,000. Deficiency cited 9/8/2021 under California Code of Regulations Section 87211(d)(5)- Reporting Requirements. POC was that the Licensee provide written notices to all residents/responsible parties, Ombudsman, and Community Care Licensing of a water service disconnection notice the facility received related to an outstanding balance. The Licensee is required to submit proof that these notices were made in order to clear this deficiency. Civil penalties assessed today at the rate of $100 per day. Today's civil penalty assessment of $600 is for the period of 10/14/2021 through 10/19/2021. Civil penalties will continue to accrue at the rate of $100 per day until submission of proof of POC. To date, civil penalties for the facility's failure to clear this deficiency total $3,400. (CONTINUED ON LIC809C)

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

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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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
	VISIT DATE: 10/19/2021

NARRATIVE

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(CONTINUED FROM LIC809)
Deficiency cited 9/8/2021 under California Code of Regulations Section 87405(a)- Administrator Qualifications and Duties. POC was that the Licensee appoint an Administrator or submit a plan with a deadline to hire an Administator. The Licensee is required to submit proof of that an Administrator has been hired or proof of a plan to hire an Administrator with a deadline date in order to clear this deficiency. Civil penalties assessed today at the rate of $100 per day. Today's civil penalty assessment of $600 is for the period of 10/14/2021 through 10/19/2021. Civil penalties will continue to accrue at the rate of $100 per day until submission of proof of POC. To date, civil penalties for the facility's failure to clear this deficiency total $3,300.

Deficiency cited 10/7/2021 under California Code of Regulations Section 87213) - Finances. POC was that the Licensee was to submit a financial plan that assures coverage of operating costs for care of residents and a plan to maintain adequate financial records. The Licensee is required to submit proof of a financial plan and a plan to maintain adequate financial records in order to clear this deficiency. Civil penalties assessed today at the rate of $100 per day. Today’s civil penalty assessment of $100 is for the period of 10/19/2021 through 10/19/2021. Civil penalties will continue to accrue at the rate of $100 per day until submission of proof of POC.

A total of $1,900 in civil penalties is being cited during today's visit. An exit interview was conducted and a copy of this report along with LIC412FCs and appeal rights were provided.

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC809 (FAS) - (06/04)

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