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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006466
Report Date: 01/16/2026
Date Signed: 01/16/2026 04:06:37 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
01/09/2026 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20260109141641
FACILITY NAME:PACIFIC COAST MENTAL HEALTHFACILITY NUMBER:
306006466
ADMINISTRATOR:CISNA, DEREKFACILITY TYPE:
772
ADDRESS:2798 WAXWING CIRCLETELEPHONE:
(949) 480-7126
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 6DATE:
01/16/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Christina FarschianTIME COMPLETED:
04:21 PM
ALLEGATION(S):
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Client was evicted illegally
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged client was evicted illegally. During the investigation, LPA conducted interviews with staff. LPA reviewed records obtained.

The investigation determined as follows: Regarding the allegation client was evicted illegally, it was reported when Client 1 (C1) was discharged from a 51/50 hold at a hospital, the facility did not accept C1 back into the facility. LPA interviews with two out of four staff stated when clients are placed on a 51/50 hold, they are discharged from the facility. One out of those two staff added discharged clients may reapply for admission into the facility. One out of the remaining two staff stated C1 contacted the admission line on December 17, 2025 to be readmitted but was told there were no beds available matching C1's gender as rooms are shared. The remaining staff stated C1 was discharged from the facility on December 10, 2025.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
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 3
Control Number 22-AS-20260109141641
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: PACIFIC COAST MENTAL HEALTH
FACILITY NUMBER: 306006466
VISIT DATE: 01/16/2026
NARRATIVE
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LPA record review revealed C1 was discharged on December 10, 2025 from the facility. Three new clients were admitted on December 10,2025; December 18, 2025; and December 19, 2025. Facility discharge documents for C1 did not include any signed acknowledgment by C1 as the discharge occurred while C1 was at the hospital.

Based on interviews conducted and record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6), is 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: 01/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260109141641
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: PACIFIC COAST MENTAL HEALTH
FACILITY NUMBER: 306006466
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
01/30/2026
Section Cited
CCR
81068.5(a)
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81068.5(a) Eviction Procedures:
The licensee shall be permitted to evict a client with 30 days' written notice for any of the following reasons:...

The requirement was not met as evidenced by:
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VP stated they will issue an 30 eviction notice to C1 with Department approval. In-service training on discharge/eviction procedures will be reviewed with staff. LPA to review by POC due date.
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The facility did not follow proper eviction procedures with C1 which poses a potential health and safety risk with 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: 01/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3