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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005893
Report Date: 08/01/2025
Date Signed: 08/01/2025 12:04:51 PM

Substantiated


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
03/04/2025 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20250304102054
FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005893
ADMINISTRATOR:COKE, BETH PH.DFACILITY TYPE:
772
ADDRESS:28334 PASEO MICHELLETELEPHONE:
(949) 371-3857
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:6CENSUS: 5DATE:
08/01/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Eric Schlothan and Christina KayananTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff did not assist resident with arranging transportation to community programs.
Staff refused to allow resident the use of a laptop to attend community meetings.
Licensee did not allow resident access to personal items.
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to finalize the complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on March 4, 2025, and the initial 10-day visit was conducted on March 10, 2025. A subsequent visit was conducted by the Department on July 15, 2025. The Department obtained copies of pertinent documents and interviewed clients in care and staff and reviewed records obtained.

The investigation determined as follows: Regarding the allegation staff did not assist resident with arranging transportation to community programs, it was reported there was inadequate staffing available to transport clients to community programs such as AA meetings.

Continued on LIC9099C dated 08/01/2025
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
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 4
Control Number 22-AS-20250304102054
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: 306005893
VISIT DATE: 08/01/2025
NARRATIVE
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The Department interviews with clients revealed that nine out of nine clients stated transportation for some outings have been cancelled or postponed. Three out of nine clients stated outings have been cancelled or postponed due to only having one care coordinator (CC) available at the house to supervise them. One out of the remaining six clients stated outings were cancelled or postponed due to no vehicle available to use during a scheduled outing. The remaining five out of five clients stated outings were cancelled or postponed due to both only having only one CC and no vehicle available to use during a scheduled outing. The Department interviews with staff regarding this allegation revealed that two out of five staff stated outings can be postponed if not enough staff is available to facilitate outings. One out of two staff added outings have been canceled due to not enough staff and or no vehicle available. The remaining three staff were unsure if outings have been postponed or cancelled. Upon record review for the week of July 12, 2025 through July 18, 2025, there were two CCs available for two out of 21 shifts. All other shifts had one CC available.

Regarding the allegation staff refused to allow resident the use of a laptop to attend community meetings, it was reported staff did not give laptop access to C1 due to lack of staff to supervise usage.

Upon records review the Department observed C1's admission agreement under the Basic Services section line Q that states, “Assistance with access to supportive services such as… community support groups, fitness and recreational activities, and vocational support services”. Staff notes dated February 13, 2025 revealed that at 5:35AM, C1 attempted to attend an online AA meeting, but was denied due to staff doing a medication audit and was told they could attend the next meeting at 6:30AM. At 2:18PM staff notes revealed that C1 had not attended a meeting at all the morning of February 13, 2025. Upon interviews it was revealed that 5 of 9 clients have asked to use a device but were denied access due to the lack of staffing being able to monitor the device being used. During interviews with staff, it was revealed that 4 of 6 staff stated that they have to monitor the clients when they are using devices and 4 of 6 staff stated that the client coordinators often work a shift alone.

Regarding the allegation licensee did not allow resident access to personal items, it was reported clients are not allowed access to shavers when needed.

Continued on LIC9099C dated 08/01/2025
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20250304102054
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: 306005893
VISIT DATE: 08/01/2025
NARRATIVE
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The Department interviews with clients revealed that three out of nine clients stated they were not allowed access to a shaver. Four out of the remaining six clients stated they were only allowed to shave when a CC was available to monitor them. One out of the remaining two clients stated they were allowed to shave with an electric shaver. The remaining client did not reveal any information regarding the allegation.

According California Code of Regulations Title 22, Division 6, Chapter 2, 81065.5 (a)(3) All facilities shall employ staff and have staffing patterns and ratios as indicated on the facility certification document.
The facility is certified as a Transitional Residential Treatment Program by the California Department of Health Care Services and as such, must comply with Title IX, section 531(b)(2) which states, "... There shall be a staffing ratio of at least one (1) full-time equivalent direct service staff for each 2.5 clients served."

Based on LPA record review, interviews with staff and clients in care, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 2), are being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20250304102054
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: 306005893
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2025
Section Cited
CCR
810.65.5(a)(3)
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81065.5(a)(3) Day Staff Ratio
All facilities shall employ staff and have staffing patterns and ratios as indicated on the facility certification document.

This requirement was not met as evidenced by:
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Licensee agrees to have adequate staffing of all shifts to meet the regulatory requirements for the facility type. Licensee agrees to forward copies of the facility schedule and hours worked by staff to verify the requirement is being met. Licensee to forward proof to LPA by 08/02/25.
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The facility did not ensure enough staffing availability to meet the needs of clients which poses an immediate health and safety risk to persons in care.
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Type A
08/02/2025
Section Cited
CCR
81072(a)(2)
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81072(a)(2) Personal Rights
Each client shall have personal rights which include...the following...to be accorded safe, healthful and comfortable accomodations, ...and equipment to meet his/her needs.

This requirement was not met as evidence by:
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Executive Director stated the facility will have an in-service training with staff regarding laptop usage and will send a copy of the their electric shaver policy along with in-service training documentation to LPA by POC due date.
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The facility did not ensure equipment was available to meet C1's needs which poses an immediate personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4