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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005893
Report Date: 12/30/2024
Date Signed: 12/30/2024 12:47:44 PM

Document Has Been Signed on 12/30/2024 12:47 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:A MISSION FOR MICHAELFACILITY NUMBER:
306005893
ADMINISTRATOR/
DIRECTOR:		COKE, BETH PH.DFACILITY TYPE:
772
ADDRESS:28334 PASEO MICHELLETELEPHONE:
(949) 371-3857
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY: 6CENSUS: 3DATE:
12/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Eric Schlothan, Lauren GrizzleTIME VISIT/
INSPECTION COMPLETED:
12:55 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) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. Facility is a licensed Transitional Social Rehabilitation Facility with a capacity for 6 ambulatory clients. The facility is a single story home with, 4 bedrooms (the master bedroom is used as a therapy room), living room, kitchen, an office, dining room, family room, office, 4 bathrooms and a 3 car garage. LPA met with Clinical Director Eric Schlothan and Program Manager Lauren Grizzle. LPA and Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the hallway next to the main entrance. LPA observed the fireplace in the living room is screened. LPA observed the kitchen is clean and organized. LPA observed the gas stove lights unassisted. The garage is used for storage. LPA observed a 3 day emergency supply of LPA observed The last emergency drill was conducted on November 11, 2024. Medication for each resident is kept in a locked cabinet in the staff office. LPA observed knives and sharp objects are kept locked in the office. LPA inspected the first aid kit. The first aid kit has all the required elements. LPA observed all the client rooms had the required furnishings. . The smoke detectors/carbon monoxide detectors tested operational. LPA observed all 4 fire extinguishers are fully charged. LPA observed all the bathrooms are clean and operational. Hot water measured 106.7 degrees Fahrenheit. The backyard has two shaded seating areas. LPA toured the backyard. There is a pool surrounded by a fence with a net on top of the pool. The pool gate is locked. LPA observed the exit gate is operational. LPA reviewed 3 client records and medications, no discrepancies observed. LPA reviewed 2 staff files, no discrepancies observed. All staff present at the facility are background cleared and associated to the facility and have CPR/First Aid training. No deficiencies are being cited as a result of this visit. 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: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2024
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