331800103-3-15-2021-18-AS-DMUN-C9CT57-20211203132455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800103
Report Date: 03/15/2021
Date Signed: 03/15/2021 03:19:32 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
03/11/2021 and conducted by Evaluator Tricia Danielson

COMPLAINT CONTROL NUMBER: 18-AS-20210311103931

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: 37	DATE:	03/15/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Carrie MacDonald, Community Resources Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Uncleared staff workers

INVESTIGATION FINDINGS:

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

Licensing Program Analysts (LPAs) Tricia Danielson and Yolanda Delgado arrived to the facility unannounce to initiate a complaint investigation into the allegations listed above. LPAs identified themselves and met with Community Resourses Director (CRD) Carrie MacDonald. LPAs discussed the purpose of the visit and the elements of the allegations with CRD MacDonald.
During today's visit, LPAs interviewed six (6) residents, five (5) staff, reviewed staff files and obtained copies of pertinent documents/records. Of the eleven (11) staff present during today's visit, LPAs discovered Staff #1 (S1)to be lacking a required fingerprint clearance. LPAs requested S1 be removed from the premises Based on LPAs observations, 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, Chapter 8 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: 03/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 18-AS-20210311103931

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: 03/15/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/16/2021 Section Cited CCR 87355(e)(1)	1 2 3 4 5 6 7	Criminal Record Clearance- (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working...licensed facility: (1) Obtain a California clearance...as required by the Department. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Licensee will obtain a criminal record clearance and request a transfer of clearance prior to S1 returning to work. The Licensee will submit a statement of understanding of the regulation cited. *Civil penalties were assessed
	8 9 10 11 12 13 14	The Licensee did not obtain a criminal record clearance for Staff #1 (S1) prior to S1 beginning employment. This poses an immediate health and safety 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: 03/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3