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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604288
Report Date: 02/02/2021
Date Signed: 02/02/2021 05:30:35 PM

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: 14DATE:
02/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:42 PM
MET WITH:Julie Bagg, VP of Operations-WestTIME COMPLETED:
04:01 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced case management visit, via video conference, due to COVID-19, to follow-up on an incident reported to Community Care Licensing. LPA Segura met virtually with Julie Bagg, Vice President of Operations-West.

Community Care Licensing received a telephone call on January 29, 2021 and an Unusual Incident/Injury Report on February 2, 2021 reporting that Resident #1 (R1) eloped from the facility on January 28, 2021.

During today's visit, LPA interviewed Julie Bagg, observed R1, toured the facility, and informed that copies of facility records would be requested. No deficiencies were cited during today’s visit.

A copy of this report and Licensee/Appeal Rights (LIC 9058 1/16) were provided to Julie Bagg via electronic mail. An electronic read receipt confirmation was requested to be sent by the Vice President of Operations-West upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021
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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