Legacy Senior Living

Type of visit: Required - 1 Year

On March 18, 2026, 12:15 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and granted entry by Caregiver (CG) Alfredo Ordona. LPA Kim spoke with Administrator (ADMIN) Ban Nguyen over the telephone and explained the purpose of the visit. ADMIN Nguyen stated they could not attend today’s visit and CG Ordona could sign in behalf of the facility.. The facility is licensed to operate for six (6) nonambulatory residents of which one (1) may be bedridden and has a hospice waiver for six (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living area, dining area, kitchen, outdoor covered patio in the backyard, and an attached two car garage. LPA Kim toured inside and outside of the physical plant. There were no obstructions in the facility. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 1, Resident Room 2, Resident Room 3, and Resident Room 4. Bathrooms were found to be clean and operational. The water temperature measured between 122.0 degrees F to 125.0 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. LPA Kim observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, toxins, and sharps objects were stored and not accessible to residents. Evaluation Report Continues on LIC 809-C The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food both were available and maintained properly. Emergency food, emergency water, and emergency supplies are stored in the garage. The facility has one (1) fire extinguisher that is charged and mounted on the wall next to the entrance. It was last serviced on December 3, 2024. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were operable except the resident hallway was missing a smoke detector and the shared resident room next to the living area did not have a battery in the detector. The facility did not have a battery to place one in the smoke detector missing the battery. A working telephone (714-916-0629) remains available. Last emergency drill was conducted on March 15, 2026 and is conducted monthly. First aid kit is maintained and contains all the necessary elements. Evidence of Liability Insurance is effective March 22, 2025, and expires March 22, 2026. The facility also provided the insurance that is effective March 22, 2026, and expires on March 22, 2027. LPA Kim conducted an audit of resident files (R1-R4), staff files (S1-S6), and medication and medication administration record. R1’s last appraisal needs and service plan was on January 13, 2023, R2’s last appraisal needs and service plan was on January 13, 2023, and R3’s pre-appraisal was not completed. LPA Kim conducted interviews with one resident and two staff. Deficiencies were cited during this visit per Title 22 Division 6 Chapter 8. LPA observed resident bathrooms hot water temperature measured between 122.0 degrees F to 125.0 degrees F. During the visit, the facility adjusted the water temperature and LPA Kim observed the resident bathrooms hot water temperature measured between 116.0 Degrees F to 118.0 Degrees F. LPA observed smoke detectors were missing in the hallway and the shared resident room next to the living area. LPA observe R1’s and R2’s last appraisal needs and service plan was from January 13, 2023 and R3’s pre-appraisal was not completed. An exit interview was conducted, and a copy of this report, LIC809D, LIC421FC, and appeal rights were provided to Caregiver Alfredo Ordona.the state’s words, verbatim · CDSS document, Mar 18, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Samer Haddadin made an unannounced visit to conduct the required annual inspection. LPA met with caregiver (staff), Alfredo Ordon, and explained the reason for the visit. LPA toured the interior and exterior portions of the facility with staff and observed the following: This is a one-story home. Facility is a 5-bedroom, 2-bathroom, 1 story house with attached garage that is being used for storage. Resident rooms were provided with furniture, chair and clean Lenin adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide and exit alarms were tested to be operational. Bathrooms were observed to be in good repair and provided with grab bars. At around 10:38Am, LPA checked the hot water temperature in both restrooms, and it measured between 94.9- and 99.1-degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements. LPA inspected kitchen appliances and noticed 2 out of 4 stove burners were not operational. Staff stated that both burners have been out since October of last year and staff advised administrator back then. Fire extinguisher was observed fully charged and indicator in the green zone with inspection date of December 6th, 2024. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards and ample space for activities. The facility has a pool that is fenced and is inaccessible to residents in care Kitchen was in good repair with cleaning supplies and sharp items inaccessible to residents in care. Medications are kept locked separately in hallway. LPA reviewed two residents’ files and medications with no discrepancies observed. All files of staff and residents contained all required documentation. Upon review of records, the facility could not provide any log regarding the required quarterly fire drill. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights provided to AD at end of inspection.the state’s words, verbatim · CDSS document, Mar 21, 2025