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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604727
Report Date: 04/17/2024
Date Signed: 04/17/2024 04:06:25 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240410115027
FACILITY NAME:LANCE PLACEFACILITY NUMBER:
374604727
ADMINISTRATOR:MASONER, EVAFACILITY TYPE:
735
ADDRESS:10056 ROTHGARD RDTELEPHONE:
(858) 262-3057
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 2DATE:
04/17/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Eva Masoner, AdministratorTIME COMPLETED:
01:58 PM
ALLEGATION(S):
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Licensee does not ensure that residents' dietary needs are met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to open a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Eva Masoner, Administrator to discuss the purpose of the visit.

LPA conducted the investigation visit and was able to interview clients, facility staff, and outside sources. LPA also reviewed records and conducted a physical inspection of the facility. It was alleged that the licensee does not ensure that residents' dietary needs are met. Interviews revealed that there are only two clients that live at the facility. According to the two clients physicians reports dated 03/15/2024 and 03/28/2024 it does not report that the two clients are on any type of special diets.
Interviews with staff revealed the clients eat a variety of fruits and vegetables along with grains, yogurt and meats. Observations revealed the facility has an updated menu that is completed and renewed every two weeks and the staff adhere to the facility menu for the clients. LPA observations revealed several different meals in the refrigerator along with many items to choose from for snacks and dinner ideas. Interviews revealed sometimes the menu can change if a client wants leftovers or something different for dinner. Interviews with an outside source revealed they have not had any issues with the facility or with the meals/foods being served. Interviews with clients also revealed that clients eat different meals and have different snacks. One client pointed to the foods they eat and pointed to chicken and french fries in the fridge along with salad and grapes.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20240410115027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LANCE PLACE
FACILITY NUMBER: 374604727
VISIT DATE: 04/17/2024
NARRATIVE
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The investigation did not produce supporting evidence or supporting witness statements to substantiate the licensee does not ensure that residents' dietary needs are met. Based on the evidence obtained from interviews, observations and record review, the complaint allegation is unsubstantiated.

An exit interview was conducted with Eva Masoner, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2