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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604288
Report Date: 01/26/2021
Date Signed: 01/27/2021 08:30:30 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CADENCE AT POWAY GARDENS - THE PALMSFACILITY NUMBER:
374604288
ADMINISTRATOR:BOTTOM, JASONFACILITY TYPE:
740
ADDRESS:12708 MONTE VISTA RDTELEPHONE:
(858) 312-8492
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:24CENSUS: 17DATE:
01/26/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Julie Bagg, Executive DirectorTIME COMPLETED:
12:15 PM
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Licensing Program Manager (LPM), Denise Powell; County of San Diego Contractors, Sandra Brackman and Jeff Meilander; California Department Public Health (CDPH), and Health Facility Evaluator Nurse (HFEN), Michelle Hose with the HAI Program, conducted an on-site visit. LPM and team identified themselves, were granted entry, and discussed the purpose of the visit with Executive Director (ED) Julie Bagg and Resident Services Director (RSD) Sherryl Anding.

The Department and HAI conducted the on-site visit to provide additional technical assistance and to evaluate the facility's disinfection and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed ED and RSD and provided consultation to these facility representatives along with on-site care staff. The team conducted a walk-though of the facility and a debriefing was conducted at the conclusion of the visit. Follow up staff training on PPE is recommended, along with additional guidance and implementation of effective cohorting strategies of residents as part of mitigation plan.

During today's visit, no deficiencies were issued. An exit interview was conducted and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided via electronic mail. An electronic receipt of confirmation was requested to be sent by the facility representative upon receipt of these documents.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: 619-301-9770
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2021
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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