<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 04/16/2021
Date Signed: 04/16/2021 11:51:40 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: 38DATE:
04/16/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dilma Lozano, Lead Med TechTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Tricia Danielson conducted an unannounced plan of correction (POC) visit to verify corrections of citations issued during previous visits. LPA met with Dilma Lozano, Lead Med Tech.

The following deficiencies were not corrected by the POC due date nor at the time of this visit. Civil penalties are being assessed and will continue to accrue until corrections have been submitted:

Deficiency cited under Title 22, Health and Safety Code 1569.686(a) - Licensee notification of specified events. Licensee's POC was to provide written notices of the facility's mortgage default to all residents, and, if applicable, their legal representatives, as well as all applicants for potential residence, and, if applicable, their legal representatives by POC due date of 03/24/2021. On 03/23/2021, Licensee requested an extension of the due date in order to complete the POC. The date Licensee requested was 03/26/2021. To date, the notices have to been made. Civil penalties assessed today at the rate of $100.00 per day. Today's civil penalty assessment of $2200.00 is for the period of 03/26/2021 through 04/16/2021. Civil penalties will continue to accrue at rate of $100.00 per day until copies of written notices of mortgage default are submitted as proof of completion.

An exit interview was conducted and a copy of this report was provided to Ms. Lozano along with LIC 421FC- Civil Penalty Assessment- Failure to Correct and LIC 858- Appeal Rights.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1