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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005805
Report Date: 01/23/2024
Date Signed: 01/23/2024 02:22:02 PM

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
11/25/2020 and conducted by Evaluator Kimberly Lyman
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20201125123530

FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005805
ADMINISTRATOR:NARAINE, KIMBERLYFACILITY TYPE:
772
ADDRESS:24262 SUNNYBROOK CIRCLETELEPHONE:
(949) 313-4709
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 5DATE:
01/23/2024
UNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Marissa MaraTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Facility not allowing resident access to telephones in order to make and receive confidential calls.
Facility not allowing resident to possess and use his own personal items
Facility not allowing resident to possess and control his own cash resources.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. Program Director Marissa Mara arrived during the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and client as well as reviewed and obtained pertinent documentation such as admission agreement and intake documentation. Regarding the allegations that facility not allowing resident to possess and control his own cash resources, facility not allowing resident to possess and use his own personal items, and facility not allowing resident access to telephones in order to make and receive confidential calls, the investigation revealed the following: Per facility staff, clients are provided the rules regarding what items they can bring into the facility at time of admit. Client 1 (C1) signed the admission agreement on 11/23/2020 acknowledging no cell phones are allowed. Three out of three staff confirm there is a facility phone for client use and LPA observed the telephone in the facility. Facility staff indicate clients are able to use the facility phone outside of group activities and deny prohibiting phone calls. CONTINUED ON LIC 9099C DATED 01/23/2024
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20201125123530
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 306005805
VISIT DATE: 01/23/2024
NARRATIVE
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LPA observed in the admission agreement information regarding filing a complaint with Licensing, which the client acknowledged. Staff indicate that clients can file a complaint at any time but are encouraged to call licensing during business hours as Licensing is not a 24 hour business. Three out of three staff deny not allowing client to file a complaint to Licensing and client admits to being allowed to make confidential calls. Regarding calls to client families, clients are encouraged, but not required, to contact family members during normal hours per facility staff. Three out of three staff deny preventing clients from contacting family members by phone. On 11/23/2020, C1 signed the acknowledgement/ inventory list that credit cards, checks or debit cards are not allowed nor any valuables. Facility staff indicate all clients receive a copy of the paperwork they sign. Based on interviews conducted and record review, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview conducted and a copy of this report was provided.


*This is an amended report reflecting a change in verbiage.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4