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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601503
Report Date: 07/24/2023
Date Signed: 07/24/2023 02:51:00 PM

Document Has Been Signed on 07/24/2023 02:51 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:NEWPORT HOUSEFACILITY NUMBER:
198601503
ADMINISTRATOR:HARRIS, CYNTHIAFACILITY TYPE:
735
ADDRESS:1852 NEWPORT AVETELEPHONE:
(626) 797-2935
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY: 6CENSUS: 6DATE:
07/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator- Maria CarlosTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced visit at the above facility. LPA arrived at at 9:10 am for an annual inspection. LPA waited to see if any staff responded to LPA's arrival once ringing the doorbell. Due to no one answering LPA Calderon called Administrator Maria Carlos at 626-375-7941. Maria Carlos stated she is on the way to the facility to assist with the visit. LPA shortly after met with Administrator to discuss the purpose of todays visit.

The facility cares for adults with intellectual disabilities and is vendorized by Lanterman Regional Center as a Level 3 facility.

On todays visit, LPA observed the physical plant alongside with Maria Carlos. All client bedrooms were toured, total of four (4) bedrooms. Each bedroom has 2 beds (shared rooms), linen, dresser, light, and sufficient closet space. Extra linen, towels, blankets and housekeeping supplies were observed in hallway closets. Two (2) client bathrooms were toured and the hot water measured within Title 22 regulations. Bathrooms had non-skid mats in place and grab bars were observed. Hygiene supplies were observed.
All chemicals are locked in the kitchen cabinets or laundry room cabinets locked and inaccessible. The kitchen was inspected. Sharps are locked in kitchen/laundry cabinets. Kitchen was observed clean and all appliances were operable. LPA observed food supplies for breakfast and lunch. Administrator stated facility meals for dinner is provided by facility Bella Vista which is the same Licensee organization: Robsag Inc and dinner meals are delivered daily to Newport House between 10am-2pm and heated up for dinner. LPA suggested to get documentation regarding meals being prepared elsewhere. LPA observed food delivery at 12:20pm. All the appliances are clean and are operating properly. The common areas include the living room and dining area. These areas are clean and have the required furniture. Fire place is empty and secured.

Continuation 809-C...
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NEWPORT HOUSE
FACILITY NUMBER: 198601503
VISIT DATE: 07/24/2023
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LPA observed backyard, shade was provided and no large bodies of water was observed.

Carbon monoxide was tested and operable. Smoke detector was operable and tested. Fire Extinguishers were charged. Fire and Disaster Drill Conducted 7-2-2023.

Total of 6 client files were reviewed and contained appropriate documentation and 5 staff files were reviewed to confirm health screenings and fingerprint clearances. All clients' medications were reviewed, total of 6 clients. Medications are locked in cabinet above the laundry machines. Medications are documented properly and given as prescribed.

Administrator Certificate expires: 6/18/2024

Per California Code of Regulations, Title 22, there were no deficiencies observed during the visit. Exit interview held. A copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC809 (FAS) - (06/04)
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