361881276-2-13-2023-56-AS-KCLS-CPBUZ2-20230223150047

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881276
Report Date: 02/13/2023
Date Signed: 02/13/2023 01:44:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20220727154801

FACILITY NAME:	MISSION COMMONS		FACILITY NUMBER:	361881276
ADMINISTRATOR:	SORIANO, MARIAN		FACILITY TYPE:	740
ADDRESS:	10 TERRACINA BOULEVARD		TELEPHONE:	(909) 257-0721
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	59	CENSUS: 117	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Thomas Taylor Administrator		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Facility is not providing nutritious meals that meets clients dietary needs.
Roach and rodent infestation
Facility does not have enough food for clients.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA)Bernadette Allen made an unannounced visit to the facility for the purpose of delivering findings on a complaint. LPA met with Thomas Taylor Administrator who was informed of the purpose of the visit.

The investigation consisted of interviews, documentation, and observations as to Allegation (#1) Facility is not providing nutritious meals that meets client’s dietary needs and
Allegation (#3) the facility does not have enough food for clients.

LPA Allen toured the facilities kitchen with S1 and S2 the pantry and the walk-in refrigerator were inspected and there was an adequate amount of food available for residents in care. LPA also observed that there was a 7day supply of non-perishables items and a 5day supply of perishables items. The interview with S2 said that food is ordered weekly or as needed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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 56-AS-20220727154801

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: MISSION COMMONS	FACILITY NUMBER: 361881276
	VISIT DATE: 02/13/2023

NARRATIVE

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Purchase orders were provided for the month of July dated for the 14, 18, 21, and 25, 2022 as well as the weekly menu and an alternate menu for those with dietary restrictions/special diets. Interviews were conducted with six (6) residents who said that they get plenty of food to eat every day. LPA Also observed residents in the dining area eating a balance lunch.

As to allegation (#2) Roach and rodent problem.

During the interview (S1) stated that there was a problem with roaches and rodents and immediate action was taken to resolve the problem.(S1) provided a service contract that has been put in place and services have been done in the month of June, July and August 2022.

Based on observations, interviews, and documentation the above three (3) allegations finding are Unsubstantiated.

A finding of unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report with appeal rights were discussed and provided to the Thomas Taylor Administrator at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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