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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 09/10/2020
Date Signed: 02/17/2022 02:43:07 PM


Document Has Been Signed on 02/17/2022 02:43 PM - It Cannot Be Edited

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:YNDIRA LEPEFACILITY TYPE:
740
ADDRESS:73685 CATALINA WAYTELEPHONE:
(760) 773-3115
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:96CENSUS: 44DATE:
09/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Yndira Lepe, Director
Annamaria Valenzuela, Wellness Director		TIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Tricia Danielson contacted the facility via telephone to conduct a case management visit to deliver an amended report via telephone due to COVID-19 and for precautionary measures. LPA met with Director(DIR) Yndira Lepe and Wellness Director(WD) Annamaria Valenzuela and discussed the reason for today's visit. On 08/21/2020, LPA issued a report and citations regarding an incident which had been self reported by the facility. During today's visit, LPA issued an amended report which also contained an amended citation. LPA explained the reason for amending the report and reviewed the report with DIR and WD.

An exit interview was conducted with DIR and WD via telephone and a copy of this report was provided to DIR via email and an electronic email read receipt confirms receipt of these documents. DIR has also agreed to sign the report and return a copy to LPA via email and/or fax.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2020
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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