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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005676
Report Date: 01/30/2025
Date Signed: 01/30/2025 04:49:36 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
01/22/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250122175605
FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005676
ADMINISTRATOR:MEGHAN MARCUMFACILITY TYPE:
772
ADDRESS:31101 PASEO VALENCIATELEPHONE:
(949) 313-7444
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 6DATE:
01/30/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lauren Grizzle, Rey PhillipTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility does not have a Program Director
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Program Mananger Lauren Grizzle and explained the reason for the visit. LPA reviewed staff and client files and interviewed staff.

The investigation into the allegation, facility does not have a Program Director revealed the following. It was alleged that the facility does not have a Program Director. The Clinical Director and the Program Manager both reported that Staff 1 (S1) is the Program Director and has been the Program Director since October 2024. A review of records shows that S1 meets all of the Title 22 requirements for a Program Director. Based on the evidence gathered the allegation is unsubstantiated meaning that although the allegation may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
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 5
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
01/22/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250122175605

FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005676
ADMINISTRATOR:MEGHAN MARCUMFACILITY TYPE:
772
ADDRESS:31101 PASEO VALENCIATELEPHONE:
(949) 313-7444
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 6DATE:
01/30/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lauren Grizzle, Rey Genaldo TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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2
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9
Facility staff are not adequately trained
Client file records are missing and/or incomplete
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Program Mananger Lauren Grizzle and Clinical Director Rey Philip. LPA explained the reason for the visit. LPA reviewed staff and client files and interviewed staff. The investigation into the allegation, facility staff are not adequately trained revealed the following. LPA reviewed 6 staff files. LPA observed 5 out of 6 staff members did not have 20 hours of training required documented. Based on the evidence gathered the preponderance of evidence standard has been met; therefore, the above allegation is substantiated.

Regarding the allegation, client file records are missing and/or incomplete, the investigation revealed the following. LPA interviewed staff and reviewed 3 client files. LPA observed that Client 3's (C3) treatment plan did not contain documented evidence of referral follow-up plans which are required. The preponderance of evidence standard has been met; therefore, the above allegation is substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250122175605
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: A MISSION FOR MICHAEL
FACILITY NUMBER: 306005676
VISIT DATE: 01/30/2025
NARRATIVE
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Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20250122175605
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: A MISSION FOR MICHAEL
FACILITY NUMBER: 306005676
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/31/2025
Section Cited
CCR
81065(r)
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All direct care staff shall receive a minimum of 20-clock-hours of continuing education per year, which shall provide the staff with the knowledge and skills as appropriate to their job assignment. This requirement is not being met as evidenced by
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Licensee agrees to train all direct care staff so all direct care staff have 20 hours of training to meet the regulation requirment. Licensee to submit proof of training to the LPA.
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A review of staff records shows that 5 out 6 staff members did not have 20 hours of training, this poses an immediate health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250122175605
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: A MISSION FOR MICHAEL
FACILITY NUMBER: 306005676
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/07/2025
Section Cited
CCR
81068.2(b)(3)
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A written treatment/rehabilitation plan as required by California Code of Regulations, title 9, subchapter 3, article 3.5, section 532.2(c). This requirment is not being met as evidenced by...
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Licensee agrees to ensure all client treatment plans have adocumented evidence of referral follow-up plans. Licensee agrees to sign a statement of understanding for regulation 81068.2(b)(3) and to provide the statement of understanding to the LPA by the POC due date.
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LPA observed that C3's treatment plan did not contain documented evidence of referral follow-up plans, which is a potential health, safety and personal rights risk to client.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5