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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095002904
Report Date: 08/18/2022
Date Signed: 08/18/2022 03:25:02 PM

Document Has Been Signed on 08/18/2022 03:25 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:NEWPORT INSTITUTE -MONTAIREFACILITY NUMBER:
095002904
ADMINISTRATOR:BIST, KORENFACILITY TYPE:
772
ADDRESS:4670 MONTAIRE DRIVETELEPHONE:
(714) 393-3523
CITY:SHINGLE SPRINGSSTATE: CAZIP CODE:
95682
CAPACITY: 6CENSUS: 0DATE:
08/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:Korin BistTIME COMPLETED:
03:30 PM
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LPA Parks arrived on Thursday August 18, 2022 to conduct a prelicensing inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA and Administrator completed the prelicensing inspection tool domain and the facility was found to be in substantial compliance. LPA and Administrator conducted a walk through of the facility and ensured all physical plant requirements.

LPA will notify CAB that the facility is ready for licensure.

Exit interview conducted. A copy of this report was left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2022
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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