374604291-10-31-2023-08-AS-DPOL-CX5VDA-20231031162025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604291
Report Date: 10/31/2023
Date Signed: 10/31/2023 11:20:00 AM

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
07/31/2020 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20200731122443

FACILITY NAME:	CADENCE AT POWAY GARDENS - THE PINES		FACILITY NUMBER:	374604291
ADMINISTRATOR:	BOTTOM, JASON		FACILITY TYPE:	740
ADDRESS:	12750 MONTE VISTA RD		TELEPHONE:	(800) 811-9595
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 6	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	10:41 AM
MET WITH:	Donelle Williams, Executive Director		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff did not properly administer resident's medications.

Staff were not sufficient in numbers to meet residents' needs.

Staff did not meet the needs of the residents.

Licensee did not safeguard resident's property.

Facility bathroom has mold.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver findings of a complaint investigation into the above-listed allegations. LPA was granted entry into the facility and met with Donelle Williams, Executive Director, and Sherrryl Anding, Health Services Director, to whom she disclosed the reason for the visit.

Community Care Licensing (CCL) has investigated the above-listed complaint allegations. The investigation consisted of interviews with staff and outside sources, records reviews, and a tour of the facility.

It was alleged that facility staff did not properly administer resident’s medications. It was reported that medications that were prescribed to R2 were to be crushed and administered to R2 in applesauce; however, reportedly, the medications were being dissolved in water prior to being administered to the resident. Pursuant to Title 22 regulations, if resident medications are to be crushed for administration to the resident, the facility must have a physician’s order on file authorizing the medication(s) to be crushed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

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-20200731122443

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 - THE PINES	FACILITY NUMBER: 374604291
	VISIT DATE: 10/31/2023

NARRATIVE

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The investigation did not yield any order(s) issued by R2’s physician for medications to be crushed. The investigation also did not yield any evidence to corroborate that facility staff dissolved R2’s medication in water prior to administering.

The second allegation is that the facility did not have staff in sufficient numbers to meet residents’ needs. It was reported that R1 required assistance with showering; however, R1 was allowed to shower alone. The investigation did not yield any evidence to corroborate that R1 had been left alone or unsupervised by staff while showering.

The third allegation is that staff did not meet the needs of the residents. It was reported that R1 required hearing aids and, on multiple occasions, staff did not insert the hearing aids correctly. Additionally, it was reported that R1 developed a urinary tract infection as a result of not being showered by facility staff. The investigation revealed that R1 was hearing impaired and relied upon staff to assist with cleaning the hearing aids, ensuring the batteries were properly installed, and ensuring the hearing aids were in R1’s ears. The investigation also revealed that R1 was cognitively alert and able to advise when the hearing aids were not aiding the resident in hearing. The investigation produced evidence that staff who worked with R1 received training on how to properly care for and assist residents with the use of hearing aids. The investigation did not yield evidence to conclude that staff did not properly insert the hearing aids or assist R1 with the hearing aids as needed. Relative to the urinary tract infection, during the investigation, staff communication logs were reviewed, and the logs reflected that R1 received showers in accordance with R1’s established care plan. The investigation did not yield evidence to conclude that R1 was not routinely showered or that a lack of showers caused R1 to have a urinary tract infection.

The fourth allegation is that resident’s property was not safeguarded. It was reported that R2 wore dentures, and R2’s dentures broke because they were not properly stored by staff at night. Evidence yielded that R2 did wear dentures that night staff assisted the resident with storing at night and day staff assisted the resident with properly inserting in the mornings. The investigation produced evidence that R2’s dentures were broken at a time while residing in the home. The investigation did not produce evidence to conclude that the dentures were broken because they were not properly stored or due to any action or inaction on the part of facility staff.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 08-AS-20200731122443

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 - THE PINES	FACILITY NUMBER: 374604291
	VISIT DATE: 10/31/2023

NARRATIVE

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The final allegation is that the facility’s bathroom had mold. During the investigation, information was obtained to determine that facility staff on both shifts regularly cleaned the bathrooms, as well as other parts of the home. The investigation did not produce evidence to indicate or corroborate that mold was present in the residents’ bathroom.

Based upon the foregoing, the allegations identified above are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Donelle Williams, 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: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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