331800103-9-22-2021-18-AS-DMUN-C8N3AE-20211110170436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800103
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:22:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2020 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201116114702

FACILITY NAME:	LEGEND GARDENS		FACILITY NUMBER:	331800103
ADMINISTRATOR:	YNDIRA LEPE		FACILITY TYPE:	740
ADDRESS:	73685 CATALINA WAY		TELEPHONE:	(760) 773-3115
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	96	CENSUS: 33	DATE:	09/22/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Carrie MacDonald, Community Relations Director		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude a complaint investigation into the allegation list above. LPA met with Community Relations Director (CRD) Carrie MacDonald and explained the purpose of the visit.
During the course of the investigation, LPA interviewed six (6) staff, one (1) resident, and reviewed documents pertinent to the investigation. Four (4) of the six (6) staff interviewed worked in the memory care portion of the facility where the allegation took place. Of those four (4) staff, three (3) reported observing Staff #1 (S1) to have hit and/or slapped a resident. Two (2) of the three (3) staff also provided written statements detailing their observations of S1's slap of a resident.
Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code Of Regulations, Title 22, Division 6 is being cited on the attached LIC 9099 D.
An exit interview was conducted with CRD MacDonald and a copy of this report was provided along with Appeal Rights.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20201116114702

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 09/22/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/23/2021 Section Cited HSC 1569.269(a)(10)	1 2 3 4 5 6 7	Enumerated Rights; Severability- (a) Residents of residential care facilities for the elderly shall have all of the following rights:(10)To be free from...punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Due to the lack of an Administrator and Licensee's participation, LPA and CRD developed the POC. The Licensee will conduct a training of the regulation cited with all staff. Proof of this training will be provided to CCL by POC due date. CRD has agreed to notify Licensee of this POC.
	8 9 10 11 12 13 14	Based on LPA interviews and record review, the Licensee did not ensure R1 was free from punishment and physical abuse. 3 of 4 memory care staff interviewed stated they observed S1 hit/slap R1 or another resident. This poses an immediate threat to the health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC9099 (FAS) - (06/04)

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