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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604288
Report Date: 02/01/2024
Date Signed: 02/01/2024 02:42:08 PM


Document Has Been Signed on 02/01/2024 02:42 PM - It Cannot Be Edited

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:POWAY GARDENS SENIOR LIVING - THE PALMSFACILITY NUMBER:
374604288
ADMINISTRATOR:WILLIAMS, DONELLEFACILITY TYPE:
740
ADDRESS:12708 MONTE VISTA RDTELEPHONE:
(858) 312-8492
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:24CENSUS: 12DATE:
02/01/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Director of Regional Operations, Divinia Nunez, and Executive Director, Donelle WilliamsTIME COMPLETED:
02:45 PM
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Assistant Program Administrator (APA) Icela Estrada, Licensing Program Managers (LPMs) Lizzette Tellez and Jennifer Lott, conducted an Office Meeting and met with Regional Director of Operations, Divinia Nunez, and Executive Director, Donelle Williams, to discuss the current licensee status.

During today's meeting, APA Estrada and facility representatives discussed the current licensee status during the change of ownership process. Review of the Secretary of State website revealed that the Licensee, Cadence SL Poway, LLC, is currently an active entity. Ms. Nunez and Ms. Williams advised they will provide updated contact information for the licensee's senior leadership staff and maintain communication with the Regional Office.

This report was discussed with Ms. Nunez and Ms. Williams. A copy of the report, along with Appeal Rights, were provided to them at the conclusion of the visit.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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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