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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006650
Report Date: 01/08/2025
Date Signed: 01/08/2025 01:26:18 PM

Document Has Been Signed on 01/08/2025 01:26 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 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:
01/08/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Marlon RollinsTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Lydia Martinez initiated a Pre-licensing visit on 12/11/2024.

On 01/08/2025, LPA made an announced visit and met with Applicant/CEO Marlon Rollins and Component III was initiated.

LPA Martinez and Applicant/CEO Rollins discussed items that were presented during the power point presentation for informational purposes. Applicant/CEO Rollins stated he has acknowledged information and training received during todays visit. Component III was successfully completed.

This report was reviewed with Applicant/CEO Rollins 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: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
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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