<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006305
Report Date:
09/04/2024
Date Signed:
09/05/2024 03:04:26 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
09/05/2024 03:04 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
ORANGE COUNTY RO
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
ACERA HEALTH, LLC
FACILITY NUMBER:
306006305
ADMINISTRATOR/
DIRECTOR:
GOUGER, MAI
FACILITY TYPE:
772
ADDRESS:
1585 MIRAMAR DRIVE
TELEPHONE:
(949) 378-7982
CITY:
NEWPORT BEACH
STATE:
CA
ZIP CODE:
92661
CAPACITY:
6
CENSUS:
0
DATE:
09/04/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:
TIME VISIT/
INSPECTION COMPLETED:
08:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation at 8:25am. LPA was approached by neighbors stating the staff and clients moved out a week ago and were relocating to a new location nearby.
LPA attempted to call the phone number on file but there was no answer. LPA thanked the neighbors for their assistance and information.
SUPERVISORS NAME
:
Alisa Ortiz
LICENSING EVALUATOR NAME
:
RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/04/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1