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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005940
Report Date: 09/21/2022
Date Signed: 09/21/2022 02:11:50 PM


Document Has Been Signed on 09/21/2022 02:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:ADULT CARE OC ACROPOLISFACILITY NUMBER:
306005940
ADMINISTRATOR:SZALONEK, FEFACILITY TYPE:
740
ADDRESS:24685 ACROPOLIS DRIVETELEPHONE:
(626) 864-9955
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Fe SzalonekTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPAs) Albert Marin and Celine De Perio made an unannounced case management visit. LPAs met with Administrator Fe Szalonek and stated the purpose of the visit.

In conducting the investigation for the complaint filed last April 14, 2022 the following concerns were found. LPAs Marin and De Perio made consultation on California Code of Regulations Sections: 87628 Diabetes, and 87411 Personnel Requirements - General.

No citation was issued on this visit.

LPAs Marin and De Perio conducted an exit interview with AD Szalonek, and copies of this report and regulations discussed were left in the facility.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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