<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201164
Report Date: 07/22/2022
Date Signed: 07/22/2022 06:45:39 PM

Document Has Been Signed on 07/22/2022 06:45 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
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: 4DATE:
07/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Alexander Vandenbelt, Program Director
Linda Feiler, Care Coordinator		TIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/22/2022 at 4:15PM, Licensing Program Analyst (LPA) G. Luk conducted a face to face Component III presentation. LPA met with Program Director, Alexander Vandenbelt.

LPA presented Component III power point and discussed the regulations embodied in the presentation. LPA observed Program Director gained knowledge about running and maintaining the facility in accordance with Title 22 regulations.

LPA concluded Component III.

Exit interview conducted with Linda Feiler. A copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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 1