361881276-2-17-2023-56-AS-KCLS-CQ5PKQ-20230321112330

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881276
Report Date: 02/17/2023
Date Signed: 02/17/2023 03:21:30 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
02/16/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230216144821

FACILITY NAME:	MISSION COMMONS		FACILITY NUMBER:	361881276
ADMINISTRATOR:	SORIANO, MARIAN		FACILITY TYPE:	740
ADDRESS:	10 TERRACINA BOULEVARD		TELEPHONE:	(909) 793-8691
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	59	CENSUS: 124	DATE:	02/17/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Danica Turner -Resident Service Director		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Facility not storing an adequate amount of food.
Facility not serving nutritious meals to meet resident's dietary needs.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Bernadette Allen made an unannounced visit to the facility for the purpose of initiating and delivering findings on a complaint. LPA met with Danica Turner -Resident Service Director and she was informed of the purpose of the visit.

Allegation #1- Facility not storing an adequate amount of food.
Allegation #2- Facility not serving nutritious meals to meet resident's dietary needs.

The investigation consisted of interviews, observations, and documentation. LPA interviewed thirteen (13) residents and six (6) staff members who said that the residents are provided with nutritious meals daily. LPA toured the facilities kitchen and there was a sufficient amount food, there was a 7day supply of non-perishables food items and a 5day supply of perishables food items. The pantry and the walk-in refrigerator were inspected and there was an adequate amount of food available for residents in care.. During the tour of the kitchen LPA observed the staff preparing a variety of meal options for dinner including deserts.

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: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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-20230216144821

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: 02/17/2023

NARRATIVE

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LPA also observed that there were optional meals prepared for those with special dietary needs.

Staff interviews and documents confirm that food is ordered at least 2-3 times a week.

LPA also observed snacks, fruits, and water throughout the facility for the residents in care.

Based on observations, interviews, and documentation the 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 Danica Turner 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: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC9099 (FAS) - (06/04)

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