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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366413258
Report Date: 03/19/2021
Date Signed: 03/19/2021 04:25:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MISSION COMMONSFACILITY NUMBER:
366413258
ADMINISTRATOR:SPENCER, LORIFACILITY TYPE:
740
ADDRESS:10 TERRACINA BLVDTELEPHONE:
(909) 307-6251
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:59CENSUS: 49DATE:
03/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Marian SorianoTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Natalie Gayoso contacted the facility via telephone due to COVID-19 to deliver and obtain signatures on amended complaint control # 18-AS-2020010914013. LPA introduced herself and explained the purpose of this call with Wellness Director Marian Soriano

Exit interview was conducted and a copy of this report was provided to Ms. Soriano via email.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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