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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 11/03/2021
Date Signed: 11/03/2021 11:29:05 AM

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: 31DATE:
11/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Carrie MacDonald, Community Relations DirectorTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct a case management visit in conjunction with complaint 18-AS-20210311103931 to check on the health, safety, and welfare of residents in care. LPA met with Carrie MacDonald, Community Relations Director (CRD) and explained the purpose of the visit. LPA was informed that thirty-one (31) residents currently reside at the facility at this time. There were thirteen (13) staff on duty during the time of LPA's visit.

During the visit, LPA toured the inside and outside of the facility. LPA assessed the available food supply and observed that the supply exceeds the requirement of a two (2) day supply of perishable foods and a seven (7) day supply of non-perishable foods. LPA observed all facility utilities to be on and operating without issue. LPA spoke with Med Techs in Assisted Living and Memory Care and both reported no issues with obtaining the required medications for residents. LPA observed all facility utilities to be on and operating without issue. However, on October 13, 2021, the facility received notification of termination of water services if the balance was not paid within 10 days. CRD reported no notices were made to Licensing or residents regarding the possible discontinuance of water services. This is a repeated violation of California Health & Safety Code and Code of Regulations, Title 22, Division 6, Chapter 8, Section 87211(d)(5) which was cited on 9/8/2021 and will result in the assessment of a civil penalty.

Based on the information obtained during today's visit, the following deficiencies are being cited deficiency is cited per California Health & Safety Code and Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with CRD MacDonald and a copy of this report, LIC809D, and appeal rights were provided. Community Care Licensing (CCL) will send emailed copies of this report, LIC809D, and appeal rights to Licensee as requested by Licensee.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2021
Section Cited

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Reporting Requirements- d) The licensee shall notify the Department,...all residents ...their representatives, in writing within two business days of any knowledge thereof: (5) A utility company... notice of intent to terminate...water service on the property within not more than 15 days of the notice. This requirement was not met as evidenced by:
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Based on LPA interview which was conducted and records reviewed, the Licensee did not provide notices to Licensing or residents regarding the receipt of notice of possible water shut off. This poses a potential heatlh, safety, and personal rights risk to residents in care.
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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: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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