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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006287
Report Date: 11/06/2024
Date Signed: 11/06/2024 02:58:41 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
12/27/2023 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231227124950
FACILITY NAME:MENTAL HEALTH COLLECTIVE, THEFACILITY NUMBER:
306006287
ADMINISTRATOR:ROSENBAUM, GREGORYFACILITY TYPE:
772
ADDRESS:2072 TUSTIN AVETELEPHONE:
(949) 490-4069
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY:6CENSUS: 5DATE:
11/06/2024
UNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Catherine Mann, Director of Quality and ComplianceTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Facility is not following approved plan of operation.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility following up on the investigation and delivering findings on the above allegation. LPA was greeted and granted entry into the facility by facility staff and explained the reason for the visit.
During the course of the investigation, LPA toured the facility, interviewed the Director of Quality and Compliance and gathered client records for the individuals admitted at the time of the initial visit.
Regarding the allegation that facility is not following approved plan of operation, the following is concluded: During the initial visit, LPA observed no clients on-site at the facility. Clients from all Mental Health Collective facilities attend an offsite location daily for therapy, activities and meals under the supervision of facility staff and the facility is not providing Monday through Friday daytime services at the licensed location. Based on observations and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation is deemed Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview conducted and a copy of this report along with appeal rights were provided to a facility representative.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
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 2
Control Number 22-AS-20231227124950
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: 306006287
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/22/2024
Section Cited
CCR
81022(j)
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Per CCR Section 81022(j) regarding Plan of Operations: "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 is not met as evidenced by:
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Licensee to submit a plan as to how to address the off-site services and forward proof to LPA by POC due date.
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Based on observation conducted, Licensee failed to adhere to plan of operation. Facility is conducting off-site activities daily for clients. This poses a potential health and safety risk to residents 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: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2