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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 12/23/2021
Date Signed: 12/23/2021 09:22:06 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: 9DATE:
12/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mirlan Lopez, Med TechnicianTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct a case management visit to check on the health, safety, and welfare of residents in care. LPA met with Medical Technician Mirlan Lopez and explained the purpose of the visit. LPA was informed that nine (9) residents currently reside at the facility at this time. There were ten (10) 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. The trash situation has been resolved with pick up on Monday's, Wednesdays, and Fridays. Med Tech Lopez advised there were no issues obtaining required medications for residents in Assisted Living and Memory Care.

Based on the information obtained during today's visit, no deficiencies were cited. An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
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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