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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006143
Report Date: 08/14/2025
Date Signed: 08/14/2025 03:12:16 PM

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
08/12/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250812123051
FACILITY NAME:MENTAL HEALTH COLLECTIVE, THEFACILITY NUMBER:
306006143
ADMINISTRATOR:ROSENBAUM, GREGORYFACILITY TYPE:
772
ADDRESS:519 SANTA ANA AVE.TELEPHONE:
(949) 200-9821
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 4DATE:
08/14/2025
UNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Catherine MannTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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The licensee shall provide a full copy of the current admission agreement to the client.
The needs and service plan is incomplete.
The Treatment/Rehabilitation plan was not updated as necessary to ensure accuracy.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Compliance Manager (CM) Catherine Mann, discussed the purpose of the inspection, and explained the allegations.

The investigation into the allegations that the licensee shall provide a full copy of the current admission agreement to the client, the needs and service plan is incomplete, and the Treatment/Rehabilitation plan was not updated as necessary to ensure accuracy revealed the following: During the course of the investigation, LPA inspected the facility, interviewed CM, and obtained and reviewed copies of the client roster, staff roster, Admissions Agreements, Client Handbook & Residential Client Guidelines Receipt and Acknowledgments, Biopsychosocial Assessments, Treatment/Rehabilitation Plans, and the facility’s plan of operation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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 7
Control Number 22-AS-20250812123051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MENTAL HEALTH COLLECTIVE, THE
FACILITY NUMBER: 306006143
VISIT DATE: 08/14/2025
NARRATIVE
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Regarding the allegation that the licensee shall provide a full copy of the current admission agreement to the client: it was alleged that the files for Client #2 (C2) and Client #3 (C3) did not contain documented evidence that these clients received a copy of the house rules on admission. LPA interviewed CM who denied the allegation, stating that all clients sign admission agreements and house rules acknowledgments which indicate that by signing the client confirms receipt of copies of these documents. LPA reviewed the admissions agreements for C1, C2, and C3 and noted the admission agreement indicates that by signing clients confirm that they have received a copy of the admissions agreement. However, LPA also reviewed the Client Handbook & Residential Client Guidelines Receipt and Acknowledgments for all three clients which state that by signing clients acknowledge that they have a right to receive a copy of the client handbook and/or residential client guidelines, but do not document that the clients have actually received these documents. The information obtained corroborated the allegation.

Regarding the allegation that the needs and service plan is incomplete: it was alleged that client files for Client #1 (C1) and C2 did not contain assessments of their vocational limitations. LPA interviewed CM who stated that the facility does assess clients’ vocational limitations. LPA reviewed the Biopsychosocial Assessments for C1, C2, and C3 and noted that the only vocational question is whether they are currently employed. However, this one question does not assess the clients’ vocational limitations and what supports they need to achieve their vocational goals. The information obtained corroborated the allegation.

Regarding the allegation that the Treatment/Rehabilitation plan was not updated as necessary to ensure accuracy: it was alleged that the Treatment/Rehabilitation Plan for C2 was not updated and reviewed at least once every 30 days. LPA interviewed CM who stated that C2 was admitted on April 3, 2025 and C2’s Treatment/Rehabilitation Plan was updated on April 17, 2025 and then again on May 20, 2025. LPA reviewed the facility’s plan of operation which states that the Treatment/Rehabilitation Plan must be updated every 30 days. In this case, C2’s Treatment/Rehabilitation Plan was updated more than 30 days after the last update. The information obtained corroborated the allegation.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20250812123051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MENTAL HEALTH COLLECTIVE, THE
FACILITY NUMBER: 306006143
VISIT DATE: 08/14/2025
NARRATIVE
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During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegations mentioned above. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 22-AS-20250812123051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MENTAL HEALTH COLLECTIVE, THE
FACILITY NUMBER: 306006143
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2025
Section Cited
CCR
81068(f)(1)
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81068 Admission Agreements (f) … (1) The licensee shall provide a copy of the current admission agreement to the client.... This requirement was not met as evidenced by:
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Licensee stated they will create a protocol to ensure clients receive a copy of the house rules and submit proof to LPA by POC due date.
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Based on documents, the licensee did not ensure C1, C2, and C3 received a copy of the house rules which poses a potential personal rights risk to persons in care.
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Type B
09/11/2025
Section Cited
CCR
81068.2(b)(7)
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81068.2 Needs and Services Plan (b) … (7) … the licensee shall ensure that the functional capabilities assessment … is documented … within 72 hours of admission. This requirement was not met as evidenced by:
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Licensee stated they will create a new vocational limitations assessment and submit proof to LPA by POC due date.
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Based on documents, the licensee did not ensure C1 and C2 had vocational assessments completed, which poses a potential safety 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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20250812123051
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MENTAL HEALTH COLLECTIVE, THE
FACILITY NUMBER: 306006143
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2025
Section Cited
CCR
81022(j)
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81022 Plan of Operation (j) The facility shall operate in accordance with the terms specified in the plan of operation and may be cited for not doing so. This requirement was not met as evidenced by:
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Licensee stated they retrain staff on updating the Treatment/Rehabilitation Plan as required and submit proof to LPA by POC due date.
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Based on documents, the licensee did not ensure C2’s Treatment/Rehabilitation Plan was updated every 30 days as required by the plan of operation, which poses a potential health 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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7