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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603161
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:48:20 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/25/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250225110007
FACILITY NAME:CALIFORNIA MISSION INNFACILITY NUMBER:
198603161
ADMINISTRATOR:JARED GREENFACILITY TYPE:
740
ADDRESS:8417 MISSION DRTELEPHONE:
(626) 287-0438
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:85CENSUS: 37DATE:
03/04/2025
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Heather Cummings, Business Office ManagerTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not provide resident with a 60-day notice of rent increase.
Facility has plumbing issues.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Staff, Heather Cummings. The purpose of the visit was explained. The administrator was not available during the visit.

LPA obtained a copy of the staff and resident rosters, toured the premises, and obtained documents pertaining to Resident #1.

Allegation – Staff did not provide resident with a 60-day notice of rent increase. Per the Business Office Manager, the facility had a rent increase that applied to all residents. The letter went out on 10/31/24 to inform residents and/or responsible party that an increase will take into effect on 1/1/25. LPA obtained a copy of a rent increase letter to Resident #1. The notice of increase letter was dated 11/1/24 with effective date of January 1, 2025, which was at least 60-days of notice.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
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
Control Number 28-AS-20250225110007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CALIFORNIA MISSION INN
FACILITY NUMBER: 198603161
VISIT DATE: 03/04/2025
NARRATIVE
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Staff explained that Resident #1 resides in the cottages that is considered independent living and has a separate address. Staff do not provide care or supervision to the individuals in the cottages. However, since the housing is on the premises, the rent increase had applied to the cottages as well.

Allegation – Facility has plumbing issues. Staff indicated that if they find anything in disrepair, they will put in a work order. Maintenance staff indicated they try to fix the issues right away when they receive a work order. Per staff, R1 resides in the cottages which is considered independent living and has a separate address. However, maintenance will assist with any items in disrepair if they are notified. LPA spoke to R1 who stated the plumbing issue has been resolved.

Based on information gathered, R1 has a separate address from the facility and is not receiving any care or supervision from staff. The facility roster does not contain R1’s name as part of their resident roster. Interviews with staff indicated that R1 is independent and resides in the cottages which care is not provided.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.



An exit interview was conducted with Staff H. Cummings. A copy of this report along with the appeal rights was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2