374604291-3-20-2024-08-AS-LTEZ-D3STF6-20240328144059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604291
Report Date: 03/20/2024
Date Signed: 03/20/2024 11:25:22 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
03/18/2021 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20210318144916

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:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Medication Aide Amelita Catapang, Administrator Donelle Williams, and Health Services Director Sherryl Anding		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Licensee did not abide by the admissions agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Medication Aide Amelita Catapang. LPA then met with Administrator Donelle Williams and Health Services Director Sherryl Anding, who arrived later during the visit.

The Complainant alleged Licensee did not abide by the admissions agreement because it overcharged/overbilled Resident #1 (R1) and Resident #2 (R2) for services provided.

CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of relevant facility staff and outside sources. The Department reviewed the pertinent admissions agreement, facility and third-party billing records, and date and time stamped E-mailed correspondence. [CONTINUED ON 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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-20210318144916

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: 03/20/2024

NARRATIVE

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[CONTINUED FROM 9099]

Records and interviews showed that with respect to their joint admissions agreement, Licensee did not overcharge/overbill either R1 or R2 for the services provided to them.

A preponderance of evidence does not exist to prove that Licensee did not abide by its admissions agreement with R1 and R2. The allegation is therefore unsubstantiated.

An exit interview was conducted with Williams and Anding, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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