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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603163
Report Date: 07/24/2023
Date Signed: 07/24/2023 02:43:11 PM

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
07/18/2023 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230718162329
FACILITY NAME:CALIFORNIA MISSION INN - ROSE MANORFACILITY NUMBER:
198603163
ADMINISTRATOR:DWIGHT DUNAGANFACILITY TYPE:
740
ADDRESS:4825 EARLE AVETELEPHONE:
(626) 287-0438
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:85CENSUS: 40DATE:
07/24/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Dwight DunaganTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff does not adhere to posted food menus.
Facility has inadequate food service.
Staff do not serve nutritious meals.
Facility meals are served more than fifteen (15) hours apart.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Dwight Dunagan and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Dwight Dunagan, Staff 1-3 (S1-3) and Resident 1-5 (R1-5). LPA collected copies of Staff and Resident Rosters, Facility Food Menus for June - September 2023 and a copy of Bistro Menu. LPA also conducted a tour of facility kitchen, dining room, and observed facility food supply.



(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
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 3
Control Number 28-AS-20230718162329
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 - ROSE MANOR
FACILITY NUMBER: 198603163
VISIT DATE: 07/24/2023
NARRATIVE
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Investigation revealed the following: Regarding allegation, Staff does not adhere to posted food menus, it is alleged that facility is not providing facility residents the requested or posted meals. Interviews with Administrator Dunagan and facility staff revealed that staff adhere to posted menus at all times. They stated that residents also have the option of requesting an alternate meal from the bistro menu. Staff stated that the facility serves three full meals and provides two snacks on a daily basis. Staff also stated that residents can also request additional servings of any meal if they wish. Interviews conducted with 3 out of 5 residents revealed that facility adheres to the food menus. They also stated that they are given a copy of the weekly menu the week before so that they can make their own choices and turn it in to the front desk. LPA observed residents being served lunch during tour and verified that residents were served what was listed on the menu. LPA additionally toured the facility kitchen and observed an ample amount of food. There was enough food for 7 days non perishables and 2 day perishables. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Facility has inadequate food service, it is alleged that the facility residents are not receiving an adequate amount of protein and the servings are not enough for someone of a certain height. Protein servings are allegedly 1.5 ounces of chicken. Interviews with Administrator Dunagan and facility staff revealed that the facility provides adequate food service for all residents. They stated that the facility follows menus approved and developed by a registered dietician and the menus meet the residents nutritional needs. They stated that residents also have the option of requesting an alternate meal from the bistro menu and additional servings for any meal that they have. Staff stated that the facility serves three full meals and provides two snacks on a daily basis. Staff also stated that residents also have the option of requesting a half serving which will have a smaller serving of protein. Interviews conducted with 3 out of 5 residents revealed that facility food service is adequate. They stated that they are served an adequate amount of food including protein. They also stated that they are given two snacks a day. LPA observed residents being served lunch during tour and verified that residents were served what was listed on the menu. LPA observed that residents were served an appropriate amount of protein. LPA additionally toured the facility kitchen and observed an ample amount of food. There was enough food for 7 days non perishables and 2 day perishables. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230718162329
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 - ROSE MANOR
FACILITY NUMBER: 198603163
VISIT DATE: 07/24/2023
NARRATIVE
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For allegation, Staff do not serve nutritious meals, it is alleged that residents are not being given nutritious options such as broccoli. Staff have allegedly stated that they are unable to provide the meal items due to the facility not having them. Interviews with Administrator Dunagan and facility staff revealed that the facility provides nutritious meals for all residents. They stated that the facility serves well balanced and nutritious meals that include servings of protein, carbohydrates, fruits and vegetables. They also stated that the facility follows menus approved by a registered dietician. They also stated that residents can request certain foods or different meal options on the weekly menu and that is collected at the front desk and is followed by kitchen staff according to resident's preferences. Residents also have the option of requesting an alternate meal from the bistro menu and additional servings for any meal that they have. Staff stated that the facility serves three full meals and provides two snacks on a daily basis. Interviews conducted with 3 out of 5 residents revealed that facility food service is adequate. They stated that they are served nutritious and well balanced meals. They also stated that they are given two snacks a day. LPA observed residents being served lunch during tour. LPA observed that residents were served protein, fruits and vegetables. LPA additionally toured the facility kitchen and observed an ample amount of food. There was enough food for 7 days non perishables and 2 day perishables. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Facility meals are served more than fifteen (15) hours apart, it is alleged that dinner is served too early. Dinner is scheduled for 3:30pm and residents are not given snacks. It is also alleged that residents do not receive their next meal until the following morning at approximately 9-9:30am. Interviews with Administrator Dunagan and facility staff revealed that the facility does not serve meals more than 15 hours apart. They stated that dinner is served from 4:30pm to 6:00pm and breakfast is served from 7:30am to 9:00am. They also stated that residents can also request food from the Bistro Menu when they want and residents are given 2 snacks per day. Interviews conducted with 3 out of 5 residents revealed that meals are not served more than 15 hours apart. They stated that they are satisfied with the food service and do not have any concerns regarding the times that the meals are serve. They also stated that they are given two snacks a day. LPA observed lunch service at approximately 12:00pm. LPA additionally toured the facility kitchen and observed an ample amount of food. There was enough food for 7 days non perishables and 2 day perishables. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Administrator Dwight Dunagan.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3