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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 095002903
Report Date: 05/01/2024
Date Signed: 05/01/2024 10:29:31 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2024 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 59-AS-20240307171218
FACILITY NAME:NEWPORT INSTITUTE-FERNWOODFACILITY NUMBER:
095002903
ADMINISTRATOR:MOSER, ASHLEYFACILITY TYPE:
772
ADDRESS:5841 FERNWOODTELEPHONE:
(714) 939-3523
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY:6CENSUS: 3DATE:
05/01/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Residential Supervisor Koren BistTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility septic system is in disrepair
Staff did not maintain the facility in a clean or sanitary condition
INVESTIGATION FINDINGS:
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On 5/1/24, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Residential Supervisor Koren Bist.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
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 59-AS-20240307171218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: NEWPORT INSTITUTE-FERNWOOD
FACILITY NUMBER: 095002903
VISIT DATE: 05/01/2024
NARRATIVE
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Facility septic system is in disrepair
Staff did not maintain the facility in a clean or sanitary condition
Based on record reviews, interviews and observation, the department has concluded that the facility did have a septic system that was temporarily out of order for a few hours on 3/5/24. Maintenance was called immediately and blocked the area. The area was then cleaned and sanitized. Clients used alternate doors to exit, additionally, the maintenance of the bathroom did not disrupt programming. The septic system was fixed in a few hours on 3/5/24. Although the allegation happened, the facility followed up on the situation and addressed the issue without disrupting program for the clients, therefore the allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Residential Supervisor and a copy of this report was provided to the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2