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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700258
Report Date: 05/17/2022
Date Signed: 06/02/2022 01:38:41 PM

Document Has Been Signed on 06/02/2022 01:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:LEGACY CARE LLCFACILITY NUMBER:
374700258
ADMINISTRATOR:CHAPELE, AMREFACILITY TYPE:
300
ADDRESS:2150 N CENTRE CITY PKWY STE DTELEPHONE:
(619) 734-7493
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: CENSUS: DATE:
05/17/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:N/ATIME COMPLETED:
10:00 AM
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On 5/17/2022, an attempt was made to perform an unannounced inspection of Legacy Care LLC. The analyst confirmed that the HCO no longer resides at this particular address. A licensee or designee shall be continuously present during the Home Care Organization’s (HCO) business office hours. Any additional incomplete inspections may result in the issuance of civil penalties or possible license revocation. Please notify your assigned analyst of any changes to the HCO location or anticipated hours of operation.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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