306006287-10-31-2023-22-AS-MSTC-CX5VZ4-20231031165203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006287
Report Date: 10/31/2023
Date Signed: 10/31/2023 12:32:00 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
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: 4	DATE:	10/31/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Catherine Mann and Greg Rosenbaum		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Facility did not document the client's treatment progress and reason of discharge.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman arrived at facility at 11:30 AM and knocked on the door. There was no answer and LPA contacted Administrator Greg Rosenbaum. Administrator stated would arrive shortly.
Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver amended findings on the above allegation. LPA was greeted and granted entry by Director of Quality and Compliance Catherine Mann and explained the reason for the visit. Administrator Greg Rosenbaum 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 discharge paperwork. Regarding the allegation that facility did not document the client's treatment progress and reason of discharge, the investigation revealed the following: Client #1 (C1) discharged from the facility on 07/14/2023 as the client had completed care and was discharged to a lower level of care. Facility program plan on file with the department indicates clients will be provided three referrals in accordance CONTINUED ON LIC 9099C DATED 10/31/2023

Substantiated

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: 10/31/2023

NARRATIVE

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with clinical recommendations upon discharge. While there was a reason for discharge, C1's discharge summary indicates no referrals were provided to the client. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility along with appeal rights.

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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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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/31/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/13/2023 Section Cited CCR 81022(b)(16)	1 2 3 4 5 6 7	The plan and related materials shall contain the following: Written evidence of arrangements for any consultants and community resources which are to be utilized in the facility's plan of operation or to meet regulatory requirements. This req is not being met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to conduct an in service to clinicians and forward proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on record review, Licensee failed to ensure C1 was provided three referrals/ community resources upon discharge. This poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023

LIC9099 (FAS) - (06/04)

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