306005605-7-30-2025-22-AS-APAO-DKS97W-20250821230750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005605
Report Date: 07/30/2025
Date Signed: 07/30/2025 03:49:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/02/2023 and conducted by Evaluator Celine Rodriguez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230602123201

FACILITY NAME:	SOCAL EMPOWERED LLC		FACILITY NUMBER:	306005605
ADMINISTRATOR:	JAMES PERRAIE		FACILITY TYPE:	772
ADDRESS:	22602 COSTA BELLA DR		TELEPHONE:	(949) 701-3551
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY:	6	CENSUS: 5	DATE:	07/30/2025
		UNANNOUNCED	TIME BEGAN:	12:23 PM
MET WITH:	Staff - Melanie Mitrovich		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility did not provide required activities to clients
Facility staff is not properly trained
Facility is not following their Plan of Operation for client discharge

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced continuation visit to the facility for the complaint and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, and met with staff on duty (S1) Melanie Mitrovich. S1 notified licensee (LE) James Perraie about the visit. LE provided consent for S1 to recieve and sign the report.

During the investigation, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that facility did not provide required activities to clients. LPA Rodriguez conducted a total of 5 interviews which consisted of clients and staff. 4 out of the 4 client interviews did not corroborate with the allegation by stating that facility will conduct activities such as outside activities, stress management activities, self-esteem groups, communication skills, fitness groups, along with personal time. 1 out of the 1 interview conducted with staff did not corroborate with the allegation by stating that activities are conducted daily.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025

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 22-AS-20230602123201

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SOCAL EMPOWERED LLC	FACILITY NUMBER: 306005605
	VISIT DATE: 07/30/2025

NARRATIVE

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Per record review, LPA Rodriguez observed that the facility has a weekly activity schedule and the first activity begins at 9:00AM, and activities will run until 10:00PM. It was also observed that the facility documents each client’s daily attendance for each activity via digital database (Kipu). During this visit, LPA Rodriguez observed clients socializing with each other, and engaging in activities.

It was alleged that facility staff is not properly trained. LPA Rodriguez conducted a total of 5 interviews which consisted of clients and staff. 4 out of the 4 client interviews did not corroborate with the allegation by stating that the facility staff are “good” and “knowledgeable”. 1 out of the 1 interview conducted with staff did not corroborate with the allegation by stating that each staff member will complete 20 hours (or more) of training which consist of: First-Aid, crisis prevention intervention, personal rights, client rights, supervision, intake and discharge process. Per record review, LPA Rodriguez observed that the current staff present at the facility, have completed the required trainings prior to caring for clients.

It was alleged that facility is not following their Plan of Operation for client discharge. LPA Rodriguez conducted a total of 5 interviews which consisted of clients and staff. 4 out of the 4 client interviews did not corroborate with the allegation. 1 out of the 1 interview conducted with staff did not corroborate with the allegation by stating that the process for a client’s discharge includes completing a discharge summary, aftercare plan, harm risk assessment, medication transfer and resource information. Per record review, the current clients present at the facility have not completed a discharge plan due to recently being admitted into the facility this month. LPA Rodriguez conducted a review of the discharge plan for past clients, and observed that the discharge protocol was completed, dated and signed.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted with S1 Mitrovich, and a copy of this report was explained, and provided.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Celine Rodriguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025

LIC9099 (FAS) - (06/04)

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