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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005813
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:28:26 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
05/05/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230505153140

FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005813
ADMINISTRATOR:NARAINE, KIMBERLYFACILITY TYPE:
772
ADDRESS:26972 VIA BANDERASTELEPHONE:
(949) 313-7444
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 6DATE:
01/26/2026
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Eric SchlothanTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not ensure resident was taking medication as prescribed
Staff did not ensure that resident's mental health needs were met
Staff did not ensure that resident's dietary needs were met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Clinical Director Eric Schlothan and explained the reason for the visit.

The investigation into the allegation, Staff did not ensure resident was taking medication as prescribed, revealed the following. It was reported that Client 2 (C2) did not receive their Gabapentin even though it was prescribed when they moved into the facility. C2 reported that they only received Gabapentin on May 15, 2023. C2 was at the facility from April 16, 2023, to May 16, 2023. A review of records shows that C2 was prescribed Gabapentin 500mg twice a day as needed (PRN) from April 16, 2023 to May 7, 2023. On May 8, 2023 the Gabapentin prescription was changed to 300mg twice a day as needed by the physician. On May 15, the prescription was changed by C2's physician to 600mg (2 300mg capsules) 3 times a day as needed. The medication administration record shows that C2 only requested Gabapentin on May 15, 2023 and took the medication twice (2 300mg capsules twice), once at 1:00pm and at 9:00pm.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
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-20230505153140
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: 306005813
VISIT DATE: 01/26/2026
NARRATIVE
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3 Staff interviewed stated that PRN medications are only administered when requested by clients and are not offered to clients. C2 would not answer questions about their medication. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff did not ensure that resident's dietary needs were met, revealed the following. C2 moved into the facility on April 16, 2023, and moved out on May 16, 2023. It was reported that C2 was not fed properly and did not eat for the first 2 days in the facility and only ate half of their required calories during their stay. 3 out of 3 staff interviewed reported that they had observed C2 eating their meals and don't recall them not eating or requesting anything special except for Ensure protein shakes. A review of Client notes shows that on April 18, 2023, staff observed that C2 ate all of their lunch and reported they ate waffles for breakfast. Client notes for C3 for April 19 reported C2 ate breakfast and lunch. Client notes for C2 for April 30, 2023 show that C2 participated in the grocery ordering group. Client notes for C2 for May 15 show C2 ate dinner. C2 reported that they did not eat enough because the proper foods they requested were not required. C2 did not name the requested foods except for Ensure protein shakes. According to C2's admission documents they were admitted for psychosis and not for eating disorders. C2 reported they had previously seen a dietician due to picky eating. 3 out of 3 staff reported that any food requested by clients is provided and clients can eat when ever they want. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur.

The investigation into the allegation, staff did not ensure that resident's mental health needs were met, revealed the following. C2 was at the facility from April 16, 2023 to May 16, 2023. No specific details were provided regarding what mental health needs were not met. According to facility records C2 participated in at least one group therapy session every day from April 17, 2023 to May 15, 2023. C2 had 4 weekly individual therapy sessions which are overseen by a Licensed Marriage and Family Therapist (LMFT) on April 17, April 24, May 1 and May 8, 2023. C2 was interviewed and did not provide any specific details concerning what needs were not met. C2 participated in numerous therapy sessions provided by the facility. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or are valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4