306006287-10-31-2023-22-AS-MSTC-CX5VZ5-20231031165203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006287
Report Date: 09/28/2023
Date Signed: 10/31/2023 12:30:38 PM

Unsubstantiated

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
09/26/2023 and conducted by Evaluator Kimberly Lyman

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230926121245

FACILITY NAME:	MENTAL HEALTH COLLECTIVE, THE		FACILITY NUMBER:	306006287
ADMINISTRATOR:	ROSENBAUM, GREGORY		FACILITY TYPE:	772
ADDRESS:	2072 TUSTIN AVE		TELEPHONE:	(888) 717-9555
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92660
CAPACITY:	6	CENSUS: 5	DATE:	09/28/2023
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Greg Rosenbaum and Catherine Mann		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Facility did not provide details of the recreational activities

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman arrived at facility at 10:22 AM and knocked on the door. There was no answer and LPA contacted Administrator Greg Rosenbaum. Administrator stated would arrive in approx 8 minutes. Administrator arrived at 10:30 AM.
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initate an investigation into the above allegations. LPA was greeted and granted entry by Administrator Greg Rosenbaum and explained the reason for the visit. Director of Quality and Compliance Catherine Mann arrived during the visit.
During the course of the investigation, LPA toured the facility, interviewed staff as well as reviewed and obtained pertinent documentation such as activity schedule and discharge paperwork. Regarding the allegations that facility did not provide details of the recreational activities and facility did not document the client's treatment progress and reason of discharge, the investigation revealed the following: LPA observed two different activity schedules posted in the facility. Schedules included activities including outings in the community, exercise, art therapy and group activites. CONTINUED ON LIC 9099C DATED 09/28/2023

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

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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Control Number 22-AS-20230926121245

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: 306006287
	VISIT DATE: 09/28/2023

NARRATIVE

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Due to conflicting information, LPA is unable to corroborate the allegations. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided.

*This is an amended report to reflect the removal of allegation "Facility did not document the client's treatment progress and reason of discharge."

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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