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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 12/10/2021
Date Signed: 12/10/2021 04:16:55 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: 23DATE:
12/10/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Robert Cantoria, Temporary ManagementTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct a case management visit. LPA met with Robert Cantoria, Temporary Manager and explained the purpose of the visit.

Community Care Licensing (CCL) received notification from the facility regarding an incident. During today's visit, LPA interviewed one (1) resident, eleven (11) staff, and reviewed pertinent documents.

No deficiencies were cited at this time. An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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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