374604289-2-20-2024-08-AS-LTEZ-D2VVW7-20240228154727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604289
Report Date: 02/20/2024
Date Signed: 02/20/2024 01:42:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/07/2020 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20201207153212

FACILITY NAME:	CADENCE AT POWAY GARDENS - MOUNTAIN VISTAS		FACILITY NUMBER:	374604289
ADMINISTRATOR:	BOTTOM, JASON		FACILITY TYPE:	740
ADDRESS:	12695 MONTE VISTA RD		TELEPHONE:	(858) 312-5406
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	32	CENSUS: 10	DATE:	02/20/2024
		UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Donelle Williams, Executive Director		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility did not assist resident with activities of daily living.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Donelle Williams, Executive Director, to whom she disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above-listed complaint allegation. The investigation consisted of a tour of the facility, review of facility and outside source records maintained at the facility, and interviews of staff and outside source.

It was reported to CCL that Resident 1 (R1), who had a diagnosis of Alzheimer’s Disease and had been a resident of the facility since February 2019, was admitted into the hospital on November 25, 2020 because of a fever, respiratory distress, and increased lethargy. It was reported that, at the time of admittance, R1 had been starved, was dehydrated, and had not been receiving baths from facility staff.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20201207153212

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 VISTAS	FACILITY NUMBER: 374604289
	VISIT DATE: 02/20/2024

NARRATIVE

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The investigation yielded that R1, who had been a resident of the facility almost two years, had been admitted into and had been receiving hospice services prior to being admitted into the hospital. Records reviewed during the investigation indicated that R1 was scheduled to receive a visit from a hospice nurse one time per week and receive a bath from hospice personnel two times per week. Records reflected that R1 regularly received routine and unscheduled visits from hospice personnel. Interviews and records revealed that R1’s condition progressively declined while receiving hospice services, and a day prior to admittance into the hospital, R1 began to receive intensive comfort care.

The investigation further yielded, through interviews and records, that R1’s food and water intake had decreased to minimal amounts, despite staff’s efforts, which was found to be well documented. It was discovered that, pursuant to physician’s orders, R1 had been placed on a pureed diet in an effort to encourage intake of more food. It was also discovered through the investigation that R1’s responsible party was made aware of R1’s poor appetite almost a week prior to admittance into the hospital and acknowledged awareness. Records documented that R1 was receiving hospice services with a diagnosis of Alzheimer’s Disease, which often causes residents to stop swallowing or intaking food and liquids as the disease progresses. The investigation did not produce evidence to conclude that R1 was not being provided or intaking food or water due to inaction by facility staff.

Interviews and records also confirmed that R1’s baths were to be given by hospice personnel, with the assistance of one facility staff person, and there was no evidence discovered in the investigation to conclude that baths were not being given.

Based upon the foregoing and due to lack of corroborating evidence to conclude otherwise, the allegation is unsubstantiated. This finding means that there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Donelle Williams, Executive Director, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Executive Director at the conclusion of the visit. Her signature below serves as acknowledgment of receipt of copies of the report and rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

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