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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201164
Report Date: 01/25/2024
Date Signed: 01/25/2024 11:55:05 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/22/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240122171941
FACILITY NAME:NEWPORT INSTITUTE - KILKAREFACILITY NUMBER:
019201164
ADMINISTRATOR:KORELIN, SARAFACILITY TYPE:
772
ADDRESS:227 KILKARE ROADTELEPHONE:
(714) 393-3523
CITY:SUNOLSTATE: CAZIP CODE:
94586
CAPACITY:6CENSUS: 6DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alvaro Zambrano, Residential SupervisorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Licensee is not revealing the license number in all advertisements.
INVESTIGATION FINDINGS:
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On 1/25/2024 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings regarding the allegation above. LPA met with Residential Supervisor, Alvaro Zambrano and informed him of the reason for the visit.

During the course of investigation, LPA interviewed staff. LPA reviewed facility website and magazine advertisement. LPA observed magazine advertisement has two QR codes which leads to facility website. However, the magazine advertisement itself does not include facility license number.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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 15-AS-20240122171941
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: NEWPORT INSTITUTE - KILKARE
FACILITY NUMBER: 019201164
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2024
Section Cited
CCR
81011(a)
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Advertisements and License Number. Licensees shall reveal each facility license number in all advertisements... This requirement is not met as evidence by:
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Facility has agreed to create a plan to include facility license number in all advertisements and submit a copy of the plan to CCLD by POC date.
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Based on investigation, licensee did not comply with the section cited above by not having license number in all advertisements which poses a potential health and safety risk to the persons 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.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2