331800103-4-22-2021-18-AS-TDAN-C2BPWF-20210422114040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331800103
Report Date: 03/18/2021
Date Signed: 04/22/2021 11:40:50 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 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: 38	DATE:	03/18/2021
TYPE OF VISIT:	Office	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Mark Hellickson, Managing Partner		TIME COMPLETED:	04:08 PM

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	Regional Manager Leslie Mendiveles, Licensing Program Manager Reyna Lacey and Licensing Program Analyst Tricia Danielson met with Mark Hellickson to discuss Senate Bill 897 (SB 897), after Community Care Licensing received information that the Licensee received a notice of default on March 2, 2021. RM Mendiveles and LPM Lacey advised of the responsibilities of the Licensee regarding this issue. The 2011 Senate Bill 897 (SB 897) added Section 1569.686 to the Health and Safety Code establishing the Residential Care Facility for the Elderly Residents Foreclosure Protection Act of 2011. The Residential Care Facility for the Elderly Residents Foreclosure Protection Act of 2011 requires Licensees to notify the following parties in writing within two business days following the receipt of a notice of default: 1) The Department of Social Services 2) State Long-Term Care Ombudsman California Department of Aging 1300 National Drive, Suite 200 Sacramento, CA 95834-1992 3) Residents and, if applicable, their legal representatives. A notice must also be made to an applicant for potential residence and their legal representative. The applicant notice does not have to be in writing. In order to comply with the provisions of this law, a Licensee in default is required to report so to the above entities. Notices to all parties are required to be made in writing. Per Health and Safety Code Section 1569.686(c), a civil penalty shall be assessed up to $100.00 for each day the Licensee does not provide the required notification. The total civil penalty cannot exceed $2,000. (CONTINUED ON LIC 812C)

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
	VISIT DATE: 03/18/2021

NARRATIVE

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(CONTINUED FROM LIC 812)
The following deficiency is cited per California Health & Safety Code and Code of Regulations, Title 22, Division 6, Chapter 8.

LPA Danielson consulted the Licensee regarding the process of requesting extensions to plan of corrections due dates. In brief, the process is for the Licensee to make any extension requests in writing prior to the due date and send such request to the LPA. The request must include the section cited for an extension, the Licensee's explanation for why the extension is needed, a description of the actions the Licensee has taken to complete the plan of correction to date, the proposed date the Licensee will complete the correction and the steps the Licensee has taken to ensure resident health and safety is protected while the facility remains out of compliance. Any request may be sent by mail, hand delivered or faxed to the Regional Office at 1650 Spruce Street, Suite 200 Riverside, CA 92507 or via fax 951-248-0370.

An exit interview was conducted and a copy of this report along with appeal rights were provided via email and a read receipt confirms receipt of the report. Licensee has agreed to sign the report and returned a signed copy to LPA.

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/18/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/23/2021 Section Cited	1 2 3 4 5 6 7	(a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents...in writing, within two business days, and shall notify all applicants for potential residence...any of the following events, or knowledge of the event: This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on documents reviewed and interviews conducted, the Licensee was issued a notice of default and the Licensee did not notify all parties as required by this section. This poses a potential health, safety, and personal rights 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

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: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

LIC809 (FAS) - (06/04)

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