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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006145
Report Date: 01/20/2022
Date Signed: 09/19/2022 10:40:23 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-20211229175001
FACILITY NAME:MENTAL HEALTH COLLECTIVE, THEFACILITY NUMBER:
306006145
ADMINISTRATOR:FACILITY TYPE:
772
ADDRESS:2282 ORCHARD DRIVETELEPHONE:
CITY:NEWPORT BEACHSTATE: ZIP CODE:
92660
CAPACITY:0CENSUS: 5DATE:
01/20/2022
UNANNOUNCEDTIME BEGAN:
07:20 AM
MET WITH:Margaret Weiss, Greg RosenbaumTIME COMPLETED:
09:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlicensed Operations
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre, CDSS Investigator (CDSSI) Annette Renquist, Life Safety Specialist (LSS) Raymi Wun and Fire Marshall (FM) Kevin Bass made an unannounced visit at the facility to continue the investigation into the allegation listed above. LPA, CDSSI, LSS and FM and met with Compliance Officer (CO) Margaret Weiss and Administrator Greg Rosenbaum. LPA explained the reason for the visit. Clients declined to be interviewed. LPA interviewed staff, the compliance officer and Administrator. Administrator provided the LPA with a client roster and facility information. Administrator 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. Administrator verified that the facility does provide care and supervision for the clients residing at the facility. LPA served the Administrator with a Notice of Violation (NOV) and informed the Administrator 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)
Page: 1 of 3