LEGACY SENIOR LIVING

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(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 resident bathrooms hot water temperature measured between 122.0 degrees F to 125.0 degrees F. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2026 Plan of Correction POC cleared during the visit. The facility adjusted the water temperature and LPA observed the resident bathroom hot water temperature measured between 116.0 degrees F and 118.0 degrees F.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. 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 the resident hallway smoke detector was missing and shared resident room next to the living room smoke detector was missing a battery. LPA observed the fire extinguisher mounted by the entrance has not been serviced since December 3, 2024. This is an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/19/2026 Plan of Correction Licensee stated they will replace the smoke detectors in the resident hallway and the resident room next to the living room, and replace the fire extinguisher mounted next to the entrance. Licensee stated they will send a photo and video of the replaced smoke detectors and fire extinguisher to CCLD via email to edward.kim@dss.ca.gov by POC due date March 19, 2026.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in three out of four resident appraisal needs and service plan. LPA observed R1's appraisal needs and service dated January 13, 2023, R2's appraisal needs and service dated January 13, 2023, and R3 did not have a completed pre-appraisal needs and service plan. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/27/2026 Plan of Correction Licensee states they will complete appraisal needs and service plans for R1, R2, and R3, and send proof of completed Appraisals Needs and Service Plans to CCLD via email to edward.kim@dss.ca.gov by POC due date March 27, 2026.

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 in water temperature measured at 94.9 DF and 99.1 DF which poses an immediate health, safety risk to persons in care.

Official plan of correction

POC Due Date: 03/22/2025 Plan of Correction AD and or staff will send proof of water temperture (between 105 and 120FF) to LPA by e mail by POD due date

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, the licensee did not comply with the section cited above in having only 2 out of 4 stove burners working. which poses personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2025 Plan of Correction Stafe or licensee will send proof of all four stove burners working to LPA by POC due date

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review)], the licensee did not comply with the section cited above in not providing proof or conducting quarterly emergency drill which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/21/2025 Plan of Correction Staff and or licensee will send proof to LPA by e mail by POC due date

Official classification

Type B

Official code

87507(C)(1)

Regulation authority

CCR

What the official deficiency says

Admission Agreements 87507(C)(1)Any fee that is charged prior to or after admission, shall be clearly specified. 1.If a licensee charges a preadmission fee, the licensee must provide the applicant or his or her representative with a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund. This requirement is not met as evidenced by: On 4/2/2023, (R1) Representative paid Licensee $1000 via zelle payment to hold room for (R1)

Official plan of correction

Licensee Ban " Jason " Nguyen will provide (R1) Representative with $1000 deposit payment via zelle by 4/28/2023 and submit proof of understanding of CCR 87505 to CCL by 4/28/2023. 4 of interviewees indicated no written general statement was provided to (R1) or (R1)s representative. This poses a potential risk to residents in care.

Deadline recorded: May 1, 2023. A deadline is not proof that correction was completed.