366413258-11-2-2020-18-AS-DMUN-CJJ3CT-20220922180826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413258
Report Date: 10/28/2020
Date Signed: 11/02/2020 03:56:36 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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2020 and conducted by Evaluator Naisha Kendrix

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200311084232

FACILITY NAME:	MISSION COMMONS		FACILITY NUMBER:	366413258
ADMINISTRATOR:	SPENCER, LORI		FACILITY TYPE:	740
ADDRESS:	10 TERRACINA BLVD		TELEPHONE:	(909) 307-6251
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	59	CENSUS: 35	DATE:	10/28/2020
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Interim- Administrator, Marian Soriano		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility overcharged resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Due to the Department’s implementation, and in following current public health guidance, this report will be delivered via telephone. Licensing Program Analyst (LPA) Naisha Kendrix identified herself to the Interim- Administrator, Marian Soriano, and stated the reason for the call is to deliver the finding for the above allegation.

LPA conducted interviews with the responsible party and the administrator. Both of the interviews conducted confirm that R1 was provided an initial bill with a balance. The Administrator provided a copy of the final dated 3/12/2020 showing a credit was provided to the responsible party. This agency has investigated the complaint alleging (indicate the complaint allegation). 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 allegation is UNSUBSTANTIATED.

An exit interview was conducted where this report was reviewed and provided to the Administrator via email. The Administrator will return the signed reports within 24 hours of receipt.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha Kendrix	TELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020

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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