306005676-2-6-2026-22-AS-JALE-DR2R8L-20260206114806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005676
Report Date: 02/06/2026
Date Signed: 02/06/2026 11:48:12 AM

Document Has Been Signed on 02/06/2026 11:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR/ DIRECTOR:	MEGHAN MARCUM		FACILITY TYPE:	772
ADDRESS:	31101 PASEO VALENCIA		TELEPHONE:	(949) 313-7444
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY: 6		CENSUS: 5	DATE:	02/06/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Eric Schlothan, Kerri Bamper, David Asch		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Eric Schlothan, Kerri Bamper and David Asch and explained the reason for the visit. LPA and staff toured the facility. Facility is a 3 bedroom, 3 bathroom, two story house with a kitchen, dining room, living room, family room, laundry room, therapy room and an attached 3 car garage. Facility is licensed for 6 ambulatory clients. LPA observed the fireplace in the family room is screened. The facility license is posted on the wall next to the front door. LPA observed the fir extinguisher in the kitchen and the fire extinguisher in the upstairs hallway are fully charged. The Administrator Eric Schlothan had to leave during the visit. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the kitchen is clean and organized. All appliances, refrigerator, electric stove, dishwasher and 2 ovens are clean and operational. LPA observed all medications and knives are kept locked in the downstairs storage closet. The garage is kept locked and used for storage. All cleaning supplies are kept in the garage. LPA and staff toured the second floor of the facility. The second floor is comprised of 3 client rooms and a therapy room (formerly the staff office). LPA observed all client rooms had the required furnishings and linens. LPA observed the emergency evacuation chair at the top of the stairway is mounted on the wall. LPA observed the master bedroom has a fireplace that is screened. There are 2 bathrooms upstairs, both bathrooms are clean and operational. Hot water measured 114.4 degrees Fahrenheit in the downstairs bathroom. LPA observed clean linens in the hall closet. LPA and staff toured the backyard. There is a covered patio with a table and chairs to sit outside. LPA observed the exit gate is operational. No bodies of water observed. No obstacles or hazards observed in the backyard. LPA reviewed 5 client records and medications. No discrepancies observed. LPA reviewed 4 staff files, no discrepancies observed. The 4 staff members have all the required training. All staff present at the facility are background cleared and associated to the facility.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/06/2026

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Facility has a dedicated laptop for client use. Smoke detectors/carbon monoxide detectors tested operational. The last emergency drill was conducted on January 21, 2026. No deficiencies observed during the visit. No deficiencies are being cited as a result of the this visit. LPA consulted with staff regarding reporting requirements. An exit interview was conducted and a copy of the report provided.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026

LIC809 (FAS) - (06/04)

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