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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095002904
Report Date: 08/09/2023
Date Signed: 08/09/2023 11:14:50 AM

Document Has Been Signed on 08/09/2023 11:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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:
08/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Residential Director Michelle GoodTIME COMPLETED:
11:15 AM
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On 8/9/2023 Licensing Program Analyst (LPA) Lavinia Muscan, arrived at the facility unannounced to conduct an annual visit using the CARE Tool. LPA met with Residential Director Michelle Good and explained the purpose of the visit.

LPA and Residential Director toured facility together. Areas toured include but are not limited to: common areas, client bedrooms, outside area and common restrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Residential Director completed the CARE Tool and facility was found to be in substantial compliance at this time. Facility currently has no clients at this time.

Administrator / Licensee shall contact Community Care Licensing when receiving a client.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Lavinia Muscan
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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