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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006145
Report Date: 01/09/2024
Date Signed: 01/09/2024 12:00:01 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
11/15/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231115081443

FACILITY NAME:MENTAL HEALTH COLLECTIVE, THEFACILITY NUMBER:
306006145
ADMINISTRATOR:ROSENBAUM, GREGORYFACILITY TYPE:
772
ADDRESS:2282 ORCHARD DRIVETELEPHONE:
(888) 717-9555
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 3DATE:
01/09/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Gavin Clifford-Staff, Gregory Rosenbaum-AdministratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility did not ensure that the staff assessing clients were trained in the development and modification to the needs and services plan.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on 11/15/23. LPA was greeted and granted entry into the facility and met with Staff Gavin Clifford. LPA explained the reason for the visit. Administrator (AD) Gregory Rosenbaum arrived shortly after.

On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: One of five individuals interviewed confirmed the allegation. During the investigation LPA reviewed documents including the California Department of Health Care Services (DHCS) Review Summary dated 10/24/23. Per DHCS Review Summary the facility was unable to provide documented evidence that the staff preparing the admission assessments had received training in the development of the preparation of these documents. During interviews conducted with staff, Staff 1 (S1) reported that the facility began providing in-service training on developing and
CONTINUED ON LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20231115081443
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: MENTAL HEALTH COLLECTIVE, THE
FACILITY NUMBER: 306006145
VISIT DATE: 01/09/2024
NARRATIVE
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modification of the Needs and Services as recommended by DHCS. Per S1 the training was implemented after the visit from DHCS. Records reviewed by LPA Ramirez included The Mental Health Collective In-Service Training on Expected Clinical Documentation Standards and State Requirements dated 11/01/23. Per S1 the facility has now implemented the Needs and Services Plan training during their monthly all staff meetings.

Based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: facility did not ensure that the staff assessing clients were trained in the development and modification to the needs and services plan is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.

An exit interview was conducted with Director of Quality and Compliance Catherine Mann, and a copy of this report, 9099-D Page, and Appeal Rights was left at the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20231115081443
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: MENTAL HEALTH COLLECTIVE, THE
FACILITY NUMBER: 306006145
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/09/2024
Section Cited
CCR
81065(r)(1)(D)
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Personnel Requirements (r)All direct care staff shall receive a minimum of 20-clock-hours of continuing education per year...(1)The continuing education...include...(D)Development and updating of needs and services plan. This requirement was not met as evidence by: Based on interviews
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Per AD the facility has now implemented the development and updating of the Needs and Services Plan training during their monthly all staff meetings.
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conducted and file review the facility provided their first in-service training on developing and updating of the Needs and Services on 11/01/23.
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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: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5