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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015650125
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:12:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2022 and conducted by Evaluator Alyssa Ng
PUBLIC
COMPLAINT CONTROL NUMBER: 14-CR-20220727170524
FACILITY NAME:NEWPORT ACADEMY- ARENAFACILITY NUMBER:
015650125
ADMINISTRATOR:DELGADILLO HOLVISFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 6DATE:
09/27/2022
UNANNOUNCEDTIME BEGAN:
12:51 PM
MET WITH:RayJay Peralta TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff sexually abused client in care.
INVESTIGATION FINDINGS:
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On 9/27/22 at 12:50 PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Newport Academy- Arena and spoke with Rajay Peralta, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation.
This complaint was taken as an assignment by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Eddie Phung on 07/28/2022.
During investigation, confidential interviews, police reports, and physical evidence were obtained, it was determined that a staff sexually abused client in care.
Therefore, the preponderance of evidence standard has been met, therefore the above allegation, Staff sexually abused client in care is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 84072(d)(11) Personal Rights. Please refer to attached 9099D.
An exit interview was conducted, and a copy of this report was given to RayJay Peralta, Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Helga WongTELEPHONE: (408) 277-1289
LICENSING EVALUATOR NAME: Alyssa NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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 2
Control Number 14-CR-20220727170524
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: NEWPORT ACADEMY- ARENA
FACILITY NUMBER: 015650125
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/28/2022
Section Cited
CCR
84072(d)(11)
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84072(d)(11) Personal Rights. To be free of physical, sexual, emotional, or other abuse...

This requirement was not met as evidenced by:
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Licensee agrees to hold a personal rights training regarding relationships with staff and clients, boundaries, etc. Training documents are to be sent to LPA Fremont on Oct.7th by 4:59 PM.
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Based on documentation obtained, staff sexually abused client in care, which is an immediate Health, Safety, and Personal Rights risk 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: Helga WongTELEPHONE: (408) 277-1289
LICENSING EVALUATOR NAME: Alyssa NgTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2