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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006143
Report Date: 01/20/2022
Date Signed: 01/20/2022 10:13:09 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/29/2021 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-NP-20211229174118
FACILITY NAME:MENTAL HEALTH COLLECTIVE, THEFACILITY NUMBER:
306006143
ADMINISTRATOR:FACILITY TYPE:
772
ADDRESS:519 SANTA ANA AVENUETELEPHONE:
CITY:NEWPORT BEACHSTATE: ZIP CODE:
92663
CAPACITY:0CENSUS: 1DATE:
01/20/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Greg Rosenbaum, Margaret WeissTIME COMPLETED:
10:25 AM
ALLEGATION(S):
1
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9
Unlicensed Operation
INVESTIGATION FINDINGS:
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2
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9
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Licensing Program Analyst (LPA) Joseph Alejandre, CDSS Investigator (CDSSI) Annette Renquist, Life Safety Specialist (LSS) Raymi Wun made an unannounced visit at the facility to continue the investigation into the allegation listed above. LPA, CDSSI and LSS met with Compliance Officer (CO) Margaret Weiss and Administrator (AD) Greg Rosenbaum. LPA explained the reason for the visit. One client was present at the time of visit and was not available for interview. LPA interviewed the compliance officer and AD AD provided the LPA with a client roster and facility information. AD reported that the facility has applied for a License and provided a copy of the LIC 200 along with tracking numbers showing the document was sent to CDSS in Sacramento. AD verified that the facility does provide care and supervision for the clients residing at the facility. LPA served the AD with a Notice of Violation (NOV) and informed the AD that the application will be verified. Administrator stated he understood. Based on the evidence gathered through interviews and review of documents, the preponderance of evidence standard has been met; therefore, the above allegation is substantiated. LPA Alejandre served Administrator Greg Rosenbaum a Notice of Operation in Violation of Law. An exit interview was conducted and a copy of the report provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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