LEGACY SENIOR LIVING 2

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPAs observed unsecured insulin injection pens to be stored in the kitchen refrigerator where it can be accessible to residents in care.

Official plan of correction

POC Due Date: 08/15/2026 Plan of Correction The Administrator stated that she would conduct an in service training with all facility staff regarding the storage of medications. The Administrator agreed to provide LPA proof of training via email or fax by POC due date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed that zero out of the three staff present during the visit had a CPR training card.

Official plan of correction

POC Due Date: 08/28/2026 Plan of Correction The Administrator stated that she will obtain CPR training cards for the staff to ensure that each shift has a staff member who has received CPR training. The Administrator agreed to provide LPA proof of the CPR training via email or fax by POC due date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed that the facility did not have Health Screenings or TB tests on file for Staff #1 (S1) or Staff #2 (S2).

Official plan of correction

POC Due Date: 08/28/2026 Plan of Correction The Administrator stated that she will obtain Health Screenings and TB test for S1 and S2. The Administrator agreed to provide the Health Screenings and TB tests for the staff to LPA via email or fax by POC due date.

Official classification

Type B

Official code

87355(e)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed that Staff #1 (S1) does not have a criminal record clearance. Per a review of Guardian, S1 is currently " In Process " and S1 started his employment with the facility on August 1, 2026.

Official plan of correction

POC Due Date: 08/28/2026 Plan of Correction The Administrator stated that she will ensure that S1 obtains a criminal record clearance prior to continuing employment with the facility. The Administrator agreed to update LPA on the criminal record clearance of S1 via email or fax by POC due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department… This requirement was not met evidenced by: Based on record review, Licensee failed to ensure S1 has a criminal background clearance. This poses an immediate health and safety risk to residents in care. Civil Penalty assessed during the visit.

Official plan of correction

Licensee stated they will send a statement of Acknowledgement and signature of CCR 87355(e) to CCLD via email to edward.kim@dss.ca.gov by POC due date October 22, 2025.

Deadline recorded: Oct 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed bathroom #1 measured at 132.0 degrees F and bathroom #2 measured at 132.9 degrees F. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/08/2025 Plan of Correction Licensee states they will fix the water temperature to be compliant to Title 22 regulations. Licensee will provide a 24 hour water log checkin the temperature every two hours and sending proof to CCLD via email to edward.kim@dss.ca.gov by POC due date 8/9/2025.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in one out of six stop top burners. LPA observed the front left stove top burner was not lighint up unassisted. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2025 Plan of Correction Licensee states they will fix the front left burner to turn on unassisted and send proof to CCLD via email to edward.kim@dss.ca.gov by POC due date August 21, 2025.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in two out of two staff. LPA observed S1 and S2 did not have any hours for 2025 available at the time of visit. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2025 Plan of Correction Licensee states they will send a plan for S1 and S2 to complete the 20 hours and when S1 and S2 complete the annual training hours for 2025 to CCLD via email to edward.kim@dss.ca.gov by POC due date August 21, 2025.

Official classification

Type B

Official code

87407(k)

Regulation authority

CCR

What the official deficiency says

87407(k) Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above. This poses a potential health, safety or personal rights risk to persons in care

Official plan of correction

Licensee states they will send completed POC with the following documents Administrator Certificate LIC 200, LIC 308, LIC 500, LIC 501, LIC 503, LIC 9182, and a copy of ID Card to CCLD via email to edward.kim@dss.ca.gov by POC due date June 6, 2025.

Deadline recorded: Jun 6, 2025. A deadline is not proof that correction was completed.