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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415601039
Report Date: 04/08/2025
Date Signed: 04/08/2025 03:15:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2025 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250131115024
FACILITY NAME:CADENCE MILLBRAEFACILITY NUMBER:
415601039
ADMINISTRATOR:JOAN NEWMANFACILITY TYPE:
740
ADDRESS:1201 BROADWAYTELEPHONE:
(650) 742-9150
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:165CENSUS: 141DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Interim administrator - Davina BookerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
- Staff is overcharging resident in care
- Staff are not communicating with resident's POA in a timely manner

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/08/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to open the complaint and investigate the allegations received. LPA met with interim administrator Davina Barker and explained the purpose of today's visit.

During the course of the investigation, LPA conducted interviews and reviewed documentation regarding the resident and the allegations. In regards to overcharging resident in care, it appeared to be an error in the billing system. The facility worked with the family to correct the mistake and compensate the family accordingly. In regards to no communicating with the resident's POA in a timely manner, LPA could not confirm if there was an issue regarding communication in a timely manner based on interviews and documentation observed. These allegations are unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. This report is reviewed with Davina and a copy is provided during today's visit
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2025 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250131115024

FACILITY NAME:CADENCE MILLBRAEFACILITY NUMBER:
415601039
ADMINISTRATOR:JOAN NEWMANFACILITY TYPE:
740
ADDRESS:1201 BROADWAYTELEPHONE:
(650) 742-9150
CITY:MILLBRAESTATE: CAZIP CODE:
94030
CAPACITY:165CENSUS: 141DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Interim administrator - Davina BookerTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Staff re-evaluated resident's care plan without resident's POA present
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/08/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to open the complaint and investigate the allegations received. LPA met with interim administrator Davina Barker and explained the purpose of today's visit.

During the course of the investigation, LPA conducted interviews and reviewed documentation regarding the resident and the allegations. This allegation is not in regulations. POA does not need to be present during an assessment. According to staff interviews, POA/responsible party is invited to attend assessments but if they do not attend the assessment still takes place. This allegation is unfounded as this is not a requirement in Title 22.

This agency has investigated the complaint alleging, Staff re-evaluated resident's care plan without resident's POA present. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. This report is reviewed with Davina and a copy is provided during today's visit
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2