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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006650
Report Date: 12/11/2024
Date Signed: 12/11/2024 10:56:52 AM

Document Has Been Signed on 12/11/2024 10:56 AM - 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 HEALTHFACILITY NUMBER:
306006650
ADMINISTRATOR/
DIRECTOR:		ROLLINS, MARLONFACILITY TYPE:
772
ADDRESS:6111 SEASHORE DRIVETELEPHONE:
(213) 551-7700
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92663
CAPACITY: 6CENSUS: 0DATE:
12/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Marlon RollinsTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Lydia Martinez made an announced visit to the facility for purpose of conducting a Pre-Licensing inspection. LPA arrived at the facility and was greeted and granted entry by Applicant/CEO Marlon Rollins. An application to operate a Social Rehabilitation Facility for a capacity of six (6) beds was submitted to CCL on 10/18/2024. This is a Change of Location.

LPA Martinez along with Applicant Rollins toured the facility and observed the following: Structure: The facility is a three story home with an attached 2 car garage. Rooftop terrace will have shaded seating area to accommodate the clients in care. Second floor has the deck, kitchen with working appliances, dining table, living room, laundry room, 3 bedrooms (2 private and 1 shared) and 3 bathrooms. First floor has 1 bedroom (shared), an Office, family room and 2 bathrooms. Facility's land line is (949) 200-9725. LPA observed the See Something, Say Something poster (PUB 475) posted. Client Bedrooms: The client’s bedroom are spacious and will easily accommodate the client’s belongings. All client bedrooms had the required furnishings. Appliances: Four burner gas cook top, wall oven, refrigerator, dish washer, microwave, air fryer, electric water cooler, washer and dryer are clean and in working order. Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants will be inaccessible to clients and will be stored and locked in areas on first and second floor. Signal system: There is no signal system. Staff Bedroom: No staff will be living at the facility. Staff Office Will also be used to store medications, files, and sharp objects in a locked office closet. Bathrooms: All bathrooms have working plumbing. Hot water temperature was within regulatory requirements. Linens & Hygiene Supplies: Adequate supply of linen was observed. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review. Food Service: No clients present during the visit. Applicant understand to have a 7 day non-perishable food supply and a 2 days’ perishable food supply prior to admitting their first client and at all times. Smoke Detectors: Smoke detectors and carbon monoxide detectors are operational.

(see LIC809C)
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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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
FACILITY NUMBER: 306006650
VISIT DATE: 12/11/2024
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 Medications, First-Aid Kit & Book: Medication will be stored in a locked closet located in the office. The First Aid kit was observed and has all the required elements. Resident & Staff Files: Client files will be electronic.. Pool/Jacuzzi: No pool/jacuzzi. Fire Extinguisher: All Fire Extinguishers are fully charged. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the client’s use. Fire clearance: Was approved by Fire Inspector Nadine Morris of Newport Beach Fire Department on 10/22/2024 for six (6) Ambulatory clients. Component III: Component III was waived as Applicant is an existing Licensee/Administrator for other existing facilities.

Clients will be relocated the same day as their belongings, medications, and food once the relocation has been approved. Staff will provide care and supervision during the entire moving process. Applicant to switch Liability insurance to new facility once the application is approved.

Applicant was informed Facility is ready for licensure and final approval will be processed by CAB in Sacramento.

An exit interview was conducted and a copy of this report was sent to email on file.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC809 (FAS) - (06/04)
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