<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005787
Report Date: 06/21/2023
Date Signed: 06/21/2023 11:01:07 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/17/2023 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20230117162857
FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005787
ADMINISTRATOR:WILLIAM MARAFACILITY TYPE:
772
ADDRESS:33721 BLUE LANTERNTELEPHONE:
(949) 371-3857
CITY:DANA POINTSTATE: CAZIP CODE:
92629
CAPACITY:6CENSUS: DATE:
06/21/2023
UNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Dan RobinsonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not follow doctor's medication order
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Lyman met with Program Manager Dan Robinson and Director of Quality Compliance Garry Larabee in the Orange County Regional Office to deliver an amended report for the above allegation.
During the course of the investigation, LPA toured the facility, interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as medication orders and client intake information. Regarding the allegation that staff did not follow doctor's medication order, the investigation revealed the folloiwng: Facility medication protocol is for physician to review and approve all psychotropic medications upon admittance into the facility. C1 acknowledged this process on the medication consent form. If facility physician does not approve the psychotropic drug perviously prescribed, Client is not able to have the medication while in the program. LPA reviewed approved medications and they matched approved drug list from facility physician. However, witness interviewed during the investigation indicated C1 admitted with a prescribed medication not on the medication list. Due to conflicting information, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of this report was provided..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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 3