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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006305
Report Date: 10/02/2024
Date Signed: 10/02/2024 01:56:10 PM

Document Has Been Signed on 10/02/2024 01:56 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, LLCFACILITY NUMBER:
306006305
ADMINISTRATOR/
DIRECTOR:		GOUGER, MAIFACILITY TYPE:
772
ADDRESS:1585 MIRAMAR DRIVETELEPHONE:
(949) 378-7982
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92661
CAPACITY: 6CENSUS: 0DATE:
10/02/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Chief Execuitve Officer Marlon RollinsTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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An informal conference was conducted on this date in the Orange County Adult and Senior Care Regional Office. The purpose of this informal conference was to discuss concerns regarding the operations of the facility.

Present during this meeting was Regional Manager (RM) Marina Stanic, Licensing Program Manager's (LPM's) Alisa Ortiz and Lourdes Montoya, Licensing Program Analysts (LPA's) Jenifer Tirre, Rosemarie Ruppert and Acera Health LLC, Chief Executive Officer (CEO) Marlon Rollins.

The purpose of today’s meeting was to discuss the Licensee’s accountability regarding the operations of Licensed facilities Acera Health, LLC (306006072; 306006255; 306006305; 306006131) and compliance with regulatory requirements. The following was discussed:

On September 18, 2024, the Department requested an updated Administrative Organization (LIC309) upon discovering Acera Health LLC had experienced changes to their Administrative Organization. Per conversation with CEO Rollins, Rollins was hired by Acera Health, LLC, around July 22, 2024. CEO Brandon Hilger left Acera Health on September 13, 2024. No notice of change in CEO was provided to the Department.

LPMs and LPA reviewed Acera Health’s website and observed facility license numbers for two of four licensed Social Rehabilitation Facilities are not being advertised on website. Licensee’s website shows the facility numbers on two of the four facilities mentioned above in Corona Del Mar and Costa Mesa (facility numbers 306006131 & 306006072). The two other facility numbers are not displayed on their website. During today’s meeting CEO was asked to update the Administrative Organization (LIC309) to reflect that the facility mailing address on all licensed locations matches with what is on their website and the Secretary of State website.

CONTINUED ON 809C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: ACERA HEALTH, LLC
FACILITY NUMBER: 306006305
VISIT DATE: 10/02/2024
NARRATIVE
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During today’s meeting Acera Health, LLC reported they will be retaining licensees for 306006072, 306006255,306006305 and 306006131 properties. The Department has spoken with landlords for all four properties whom reported lease agreements are current and have not lapsed. Landlords confirmed Acera Health, LLC remains in control of properties at this time. CEO reported at this time Acera Health, LLC is not retaining any clients at their four licensed properties.

During meeting CEO was given a copy of Amended 10 Day report issued on 9/17/2024 for complaint # 22-AS-20240911145701.

The following will be cited per title 22 regulations.

An exit interview was conducted with Licensee and copy of report, along with 809 D page and appeal rights has been provided

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/02/2024 01:56 PM - It Cannot Be Edited


Created By: Jenifer Tirre On 10/02/2024 at 10:07 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ACERA HEALTH, LLC
FACILITY NUMBER: 306006305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
Section Cited
CCR
81061(e)(3)

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81061 Reporting requirements (e) The Items below shall be reported to the licensing agency within 10 working days following the occurrence (3)Any change of the chief executive officer of a corporation or association. This requirement was not met as evidence by licensee failure to report
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On this date licensee notified department of title change. Licensee to update LIC 309 to department by POC due date.
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 changes in CEO. This poses a potential health & safety threat to clients in care.
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Type B
10/16/2024
Section Cited
CCR81061(e)(2)

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81061 Reporting requirements (e) The Items below shall be reported to the licensing agency within 10 working days following the occurrence (2) Any change in the licensee's or applicant's mailing address. This requirement was not met as evidence by licensee failure to report changes in address
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Licensee plans to update LIC 309 to department and update on website by POC due date.
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This poses at potential health & safety threat to clients 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.
SUPERVISOR'S NAME:Lourdes Montoya
LICENSING EVALUATOR NAME:Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/02/2024 01:56 PM - It Cannot Be Edited


Created By: Jenifer Tirre On 10/02/2024 at 10:19 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: ACERA HEALTH, LLC
FACILITY NUMBER: 306006305

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2024
Section Cited
CCR
81063(a)

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Accountability. The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation. This was not met as evidence by observations of website. This poses a potential health &safety risk to clients in care
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Licensee will update policies and procedures to communicate with the Department to make sure the facility is in compliance.Licensee to submit to department by POC due date
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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.
SUPERVISOR'S NAME:Lourdes Montoya
LICENSING EVALUATOR NAME:Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
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