374604645-8-8-2025-08-AS-APAO-DKJ75B-20250813212117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604645
Report Date: 08/07/2025
Date Signed: 08/08/2025 07:02:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
08/07/2025 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20250807140225

FACILITY NAME:	POWAY GARDENS SENIOR LIVING - THE PALMS		FACILITY NUMBER:	374604645
ADMINISTRATOR:	SHANNON HUNDLEY		FACILITY TYPE:	740
ADDRESS:	12708 MONTE VISTA ROAD		TELEPHONE:	(858) 674-1255
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	24	CENSUS: 12	DATE:	08/07/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Director Mellisa Watkins		TIME COMPLETED:	05:55 PM

ALLEGATION(S):

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Staff did not treat the resident with dignity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to commence and conclude a complaint investigation. LPA Correia was met by Executive Director (ED) Melissa Watkins, identified herself, and explained the purpose of the visit.

The Department's investigation included Staff and outside source interviews, and staff and resident records reviews.

On August 4, 2025, the Department received a complaint that alleged facility staff did not treat Resident 1 (R1) with dignity. A review of R1’s facility records revealed they were admitted to the facility on July 8, 2025, with several diagnoses including but not limited to cognitive communication deficit, Dementia, Depression, and Anxiety. Records also revealed R1 was non-ambulatory and required transfer assistance in and out of bed, assistance with ambulating throughout the facility and dressing.

[Continued on LIC 9099C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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-20250807140225

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: POWAY GARDENS SENIOR LIVING - THE PALMS	FACILITY NUMBER: 374604645
	VISIT DATE: 08/07/2025

NARRATIVE

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[Continuation of LIC 9099]

An interview conducted with Outside Source1 (OS1) revealed R1 disclosed that Staff1 (S1) was rough while they assisted them with a change of clothes and was told to “shut up”. OS1 could not determine if this was an isolated event or two events based on R1’s statement. OS1 also revealed R1 recently lost their partner of over 40 years and was relocated to their current placement and that R1 has made complaints at every prior placement. OS1 stated R1 could not provide a name of staff or date of the occurrence, just that it was a gentleman. An interview conducted with the Executive Director (ED) revealed being notified of the incident and was able to identify S1 by the staff schedule and gender. A review of S1’s records revealed no prior issues or incidents, and S1 has worked at the facility since 2020, prior to the change of ownership. An interview conducted with S1 revealed they had assisted R1 with a change of clothing (from pajamas to day clothes) but there was never an issue. The ED also revealed knowledge of R1’s history of complaints and a history of issues with R1 and male caregivers. In response, the ED assigned only female staff to assist R1 and has not had any issues since. An interview conducted with the RSD corroborated the ED's statements.

Several attempts were made to contact R1’s Responsible Party (RP) and other facility staff for statements to no avail. However, a review of R1’s Department records revealed an interview with Outside Source 2 (OS2) conducted on May 13, 2025, that revealed R1 was not oriented and made inaccurate statements.

Based on interviews and record reviews the above listed allegation was determined Unsubstantiated. This finding means the preponderance of evidence standard was not met.

An exit interview was conducted with ED Watkins and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) will be provided at the conclusion of the visit.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

LIC9099 (FAS) - (06/04)

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