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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604290
Report Date: 06/28/2021
Date Signed: 06/28/2021 07:25:45 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 - MAGNOLIASFACILITY NUMBER:
374604290
ADMINISTRATOR:BOTTOM, JASONFACILITY TYPE:
740
ADDRESS:12735 MONTE VISTA RDTELEPHONE:
(858) 312-8469
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
06/28/2021
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
03:02 PM
MET WITH:Elena Madsen, Executive DirectorTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted a case management visit to follow-up on an incident report that was submitted to Community Care Licensing (CCL). LPA was granted entry into the facility and met with Liza Rosales, Care Staff, with whom she discussed the purpose of the visit.

An incident report was received on February 2, 2021, in which it was reported that a resident eloped from Cadence at Poway Gardens-The Palms (The Palms) on January 28, 2021. During today's visit, LPA interviewed staff who worked at The Palms at the time of the incident. No deficiencies were cited during the 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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