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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005787
Report Date: 06/21/2023
Date Signed: 06/21/2023 11:00:46 AM

Document Has Been Signed on 06/21/2023 11:00 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
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
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Dan Robinson and Garry LarabeeTIME COMPLETED:
10:40 AM
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
An Informal Conference was held on this date at the Orange County Adult and Senior Care Regional Office, in Orange, California. The informal meeting process was explained to the Licensee.

At this informal conference, present were: Regional Manager (RM) Marina Stanic, Licensing Program Manager (LPM) Alisa Ortiz, Licensing Program Analyst Kimberly Lyman, Director of Quality and Compliance Garry Larabee and Program Manager Dan Robinson. The purpose of the meeting was to review requested changes to the facility's program plan.

The following Changes to program plan were discussed during the meeting:

  • Theft and loss policy to be updated. Verbiage refers to RCFE.
  • Please update/ clarify eviction procedures remove "termination" language.
  • Please outline staff qualifications, duties of staff and designation of Director qualifications.
  • Please clarify how and where clients are to be drug screened as well as ramifications of a positive test.
  • Clarify population served. Drug and alcohol addiction/ eating disorders disallowed.
  • Clarify house rules language to ensure clients and their property are not being searched.
  • Please update language to ensure staff are providing housekeeping, not clients.
  • Please update language to ensure facility is not disapproving of personal items and only documenting what the client arrives with. Facility cannot confiscate personal telephones, only restrict time on phone.
  • Please update menu to include who is catering the food provided.
  • Please update grievance procedures, wrong address is provided.
  • Please remove referral for Ombudsman as that is for RCFE facilities.

CONTINUED ON LIC 9099C DATED 06/21/2023.
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.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: A MISSION FOR MICHAEL
FACILITY NUMBER: 306005787
VISIT DATE: 06/21/2023
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
26
27
28
29
30
31
32
  • Please update admission agreement/ program plan language to ensure client personal rights are being adhered to regarding medication and physician choice.



Licensee agrees to implement changes to admission agreement/ program plan.



















Exit interview conducted and a copy of this report was provided.
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
LIC809 (FAS) - (06/04)
Page: 2 of 2