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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006305
Report Date: 04/26/2024
Date Signed: 05/07/2024 03:47:09 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 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
03/20/2024 and conducted by Evaluator Dwayne L Mason
COMPLAINT CONTROL NUMBER: 22-AS-20240320163721
FACILITY NAME:ACERA HEALTH, LLCFACILITY NUMBER:
306006305
ADMINISTRATOR:GOUGER, MAIFACILITY TYPE:
772
ADDRESS:1585 MIRAMAR DRIVETELEPHONE:
(949) 378-7982
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92661
CAPACITY:6CENSUS: 5DATE:
04/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Behavior Technician - Alex HerreraTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility does not maintain completed treatment plans for clients
INVESTIGATION FINDINGS:
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This is an amended report.

This unannounced investigation inspection by Licensing Program Analyst (LPA) Dwayne Mason Jr. is being conducted to conclude this agency’s investigation in the complaint allegation(s) mentioned above. LPA arrived at the facility and was greeted by Behavioral Technician, Alex Herrera and explained the nature of the inspection.

The department received a complaint on 3/20/2024 alleging the facility does not maintain completed treatment plans for clients. The Reporting Party (RP) disclosed that the treatment plan for one client did not contain documented evidence of an anticipated length of stay. During the investigation, the department interviewed facility staff and reviewed records.

(continued on LIC9099-C)

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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 3
Control Number 22-AS-20240320163721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ACERA HEALTH, LLC
FACILITY NUMBER: 306006305
VISIT DATE: 04/26/2024
NARRATIVE
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This is an amended report.

(continued from LIC9099)

On 3/21/2024 LPA conducted interviews with Program Director (PD) and staff. It was stated that treatment plans are populated with the client’s anticipated length of stay within five days of client’s admission into facility.

LPA obtained physical copies of all client admission agreements. LPA received electronic copies of all client treatment plans, staff personnel reports and staff training.

Based on interviews conducted and records reviewed, LPA determined the treatment plans reviewed for Client 1 and Client 2 were not populated with an anticipated length of stay at the time of inspection. LPA obtained copies of the treatment plans for Client 1 and Client 2.

During the investigation, there was sufficient evidence to substantiate the allegation of facility does not maintain completed treatment plans. The preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. See LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations

An exit interview was conducted and a copy of this report LIC9099-D and appeal rights were provided at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20240320163721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ACERA HEALTH, LLC
FACILITY NUMBER: 306006305
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2024
Section Cited
CCR
81070(a)
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Client Records 81070(a) (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client.
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Staff stated that the facility will populate treatment plans with an anticipated discharge date upon admission of each new client. Staff stated they will email LPA all current client treatment plans populated with an anticipated discharge date by the assigned POC due date of 5/24/2024.
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This requirement is not met as evidenced by:
Based on record review, the licensee did not comply with the section cited above in two out of five client treatment plans. This poses a potential personal rights risk to persons 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: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3