361881276-5-26-2023-56-AS-KCLS-CTM3XP-20230710183839

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881276
Report Date: 05/26/2023
Date Signed: 05/26/2023 01:34:59 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
05/23/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230523115825

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: 32	DATE:	05/26/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Thomas Taylor Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident is being illegally evicted.
Facility was in disrepair.
Facility staff did not ensure that resident had access to a phone while in care.
Facility staff did not ensure that resident has access to a television while in care.
Facility did not ensure that resident stayed adequately hydrated while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA)Bernadette Allen made an unannounced visit to the facility to investigate and deliver the findings for the allegations listed above. LPA met with Thomas Taylor Administrator and Danica Turner (LVN) License Vocational Nurse, and they were informed of the purpose of the visit and alleged allegations.

The investigation consisted of interviews with Two (2) Staff members, Five (5) Residents, Two (2) outside parties, files/ documentation reviewed,, and observations.

Allegation #1-Resident is being illegally evicted.

LPA Allen conducted with Staff #1 (S1) and Staff #2 (S2) both staff members have said that Resident #1 (R1) has not been given a 30day notice nor has the family/responsible parties been informed that (R1) is being evicted.One (1) outside party said that written notice of eviction was not provided only verbal notice.

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: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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-20230523115825

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: 05/26/2023

NARRATIVE

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Staff (S1) and (S2) did say that the family/responsible parties have been informed that (R1) has had a change in condition and may require a higher level of care. LPA Allen also observed documents that states there has been a change in (R1's) condition. Outside party 2 was called and it was confirmed that (R1) has had a change in condition.

As to the allegations #2, Facility was in disrepair.

LPA toured the facility and there were repairs done in the area where Five (5) residents reside. The repairs were started on 5/16/2023 with an estimated completion date of 5/18/2023, however the repairs were completed on 5/17/2023 based on documents received. Residents S1, S2, S3, S4 and S5 were moved back into their original rooms between 5/18/2023 -5/24/2023.

As to allegation #3- Facility staff did not ensure that resident had access to a phone while in care.

Interviews were conducted with the Five (5) residents who said that they did have access to a phone while in care and that they also have their pendants to call residents for help.

As to allegation #4- Facility staff did not ensure that resident has access to a television while in care.

Documents were reviewed that confirms that Five (5) residents in care were relocated to other rooms with their required furniture/personal belongings. Once the repairs were made the residents personal belongings were moved back to their original rooms. The 5 residents rooms were tour and all TV's were working.

As to allegation #5- Facility did not ensure that resident stayed adequately hydrated while in care.

Resident 1 ,2,3,4 and 5 were interviewed and they said that they get plenty of water/liquids to drink throughout the day.

Based on interviews conducted, records/documents reviewed and observations the five allegations above 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 with Thomas Taylor and Danica Turner where the report was discussed and provided at the conclusion of the visit with appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

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