361881276-2-26-2024-56-AS-EMAN-D2X2Q7-20240229163524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881276
Report Date: 02/26/2024
Date Signed: 02/26/2024 03:08:07 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
01/29/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240129163752

FACILITY NAME:	MISSION COMMONS		FACILITY NUMBER:	361881276
ADMINISTRATOR:	SARAH WOLFE		FACILITY TYPE:	740
ADDRESS:	10 TERRACINA BOULEVARD		TELEPHONE:	(909) 793-8691
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	59	CENSUS: 20	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Executive Director Sarah Wolfe		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff do not ensure facility is kept free of cockroaches for residents in care.
Staff do not ensure facility floors at the 2nd floor are in good repair.

INVESTIGATION FINDINGS:

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On 02/26/2024 at 02:15 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to deliver the findings on the complaint allegations listed above. LPA Brown was greeted and granted entrance at the reception area and LPA Brown met with Executive Director Sarah Wolfe. LPA Brown identified herself and discussed the purpose of the visit and the elements of the allegations with Executive Director Sarah Wolfe.

The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The allegation indicates Staff do not ensure facility is kept free of cockroaches for residents in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of five (5) residents indicated that staffs at the facility ensure that the facility's kept free of cockroaches. Interviews with residents revealed that if they have seen cockroaches in their room, staffs at the facility immediately act to check it and addressed the issue.
*** Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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-20240129163752

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: 02/26/2024

NARRATIVE

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Resident #1 (R1) reported to LPA Brown that staffs at the facility checked R1's room right away and the same day that R1 reported seeing cockroaches in R1's room. R1 added that R1's room was serviced by the facility's contracted exterminator the same day that R1 reported seeing cockroaches in R1's room. Interviews with five (5) of five (5) staffs indicated that they all ensure that the facility's kept free of cockroaches and if residents reported that they've seen cockroaches in their room, they are checking it immediately and if needed, they will contact their contracted exterminator to assess and treat the reported room with cockroaches. During the visit on 01/31/2024, ED Wolfe provided LPA Brown copies of the facility's contracted exterminator invoice from 07/2023 to 01/2024 and LPA Brown observed monthly services provided by the facility's exterminator from 07/2023 to 01/2024.

The second allegation indicates Staff do not ensure facility floors at the 2nd floor are in good repair. Interviews with three (3) of five (5) residents indicated that staffs at the facility ensure that the facility floors at the 2nd floor are in good repair. Three (3) residents reported to LPA Brown that they did not observe the facility floors at the 2nd floor in disrepair. Five (5) of five (5) staffs interviews indicated that they all ensure that the facility floors at the 2nd floor are in good repair. Staffs interviews revealed that no incident happened at the facility that the facility floors at the 2nd floor are in disrepair and no incident happened at the facility that a staff did not ensure the facility floor at the 2nd floor are in good repair. During the visit on 01/31/2024, LPA Brown observed that the floor at the 2nd level of the facility are in good repair.

Based on the evidence, the allegations that Staff do not ensure facility is kept free of cockroaches for residents in care (Allegation #1) and Staff do not ensure facility floors at the 2nd floor are in good repair (Allegation #2) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099, was discussed and provided to Executive Director Sarah Wolfe.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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