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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604289
Report Date: 06/28/2021
Date Signed: 06/28/2021 07:40:25 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 - MOUNTAIN VISTASFACILITY NUMBER:
374604289
ADMINISTRATOR:BOTTOM, JASONFACILITY TYPE:
740
ADDRESS:12695 MONTE VISTA RDTELEPHONE:
(858) 312-5406
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:32CENSUS: 17DATE:
06/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:13 PM
MET WITH:Elena Madsen, Executive DirectorTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted a health and safety check in response to a report that was received by Community Care Licensing (CCL) on 6/28/2021. LPA was granted entry into the facility by Mark Deleon, Care Staff, and met with Aurea Beltran, Med Tech, with whom she discussed the purpose of the visit.

During today's visit, LPA toured the facility, observed residents, and spoke with staff and Elena Madsen, Executive Director. No health or safety concerns were observed during the visit. No deficiencies were cited during today's visit.

An exit interview was conducted with Elena Madsen, Executive Director, and a copy of this report and licensee appeal rights were provided via electronic mail. Confirmation of receipt is requested to be sent to LPA 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: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
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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