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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005881
Report Date: 11/22/2022
Date Signed: 11/22/2022 02:36:23 PM

Document Has Been Signed on 11/22/2022 02:36 PM - 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:
306005881
ADMINISTRATOR:GUASTELLO, TEDFACILITY TYPE:
772
ADDRESS:26065 WATERWHEEL PLACETELEPHONE:
(949) 371-3857
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 6CENSUS: 4DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Dan RobinsonTIME COMPLETED:
03:00 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) Jessica Cho arrived at A Mission for Michael to conduct an unannounced Required 1 Year Inspection with an emphasis on Infection Control. Approximately 12:46pm, LPA Cho was greeted and granted entry by Care Staff Mariela Hernandez. Also present was Care Staff Andrea Moore. LPA met with Program Director (PD) Dan Robinson. LPA completed the Coronavirus 2019 (COVID-19) screening procedure upon entry. There are no active COVID-19 cases as of today. LPA observed a mounted infrared thermometer along with a check-in station that recorded temperatures of visitors on a sign in sheet. LPA observed the required COVID-19 precautionary signs posted throughout the facility. The Complaint Poster (PUB475) met the size requirement.

LPA Cho conducted a tour of the physical plant with PD Robinson. There are a total of three client bedrooms and two client bathrooms on the second floor. There is a private staff bathroom. LPA checked the client bedrooms. The client bedrooms had the required furnishings. The client bathrooms were checked. The toilets worked properly, showers were free of mold/mildew, bathrooms were adequately stocked with hand soaps and paper towels. Hand washing signs were observed in the bathrooms. The hot water temperature in the client bathrooms measured at 114.6 degrees Fahrenheit in Bathroom #1 and 117.6 degrees Fahrenheit in Bathroom #2. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. The fire extinguishers were mounted, fully charged, and serviced on 09/21/2022. Smoke/carbon monoxide detectors were tested and operational. Medications, toxins, and sharps were locked and inaccessible to the clients. LPA Cho toured the outside grounds. There was shading and sufficient seating for clients. The exit gate was self-closing and self-latching. Walkways around the facility were clear of hazards, and LPA observed sufficient supply of emergency food/water and PPEs.

Based on the observations made during today's visit, no deficiency is cited in this review as per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Program Director Dan Robinson, and a copy of this report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2022
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 1