216804061-1-12-2024-21-AS-VBEI-CZJUMA-20240116144201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804061
Report Date: 01/12/2024
Date Signed: 01/12/2024 03:05:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/19/2023 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20231019112245

FACILITY NAME:	NEWPORT INSTITUTE - BAYVIEW		FACILITY NUMBER:	216804061
ADMINISTRATOR:	MAXWELL KELLER		FACILITY TYPE:	772
ADDRESS:	285 MARGARITA DRIVE		TELEPHONE:	(714) 393-3523
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94901
CAPACITY:	6	CENSUS: 5	DATE:	01/12/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Residential Supervisor, Hope Hurst		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff inappropriately handled resident in a rough manner while in care
Staff did not treat resident with dignity and respect while in care

INVESTIGATION FINDINGS:

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At approximately 12:30PM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Complaint Investigation regarding the above allegations and met with Residential Supervisor, Hope Hurst.

During the course of the Investigation, LPA requested and reviewed documents and conducted interviews. There is an allegation that Staff inappropriately handled resident in a rough manner while in care. Reporting Party alleges that on 10/15/2023, staff used physical force on Client 1 (C1) to get a confession. Reporting Party alleges that staff shook C1 roughly, threw blankets off of C1, left C1 exposed to cold air, and laughed at C1. Reporting Party was unable to provide additional or clarifying information regarding alleged confession. LPA conducted staff and client interviews. Staff interviews conducted stated that they have never seen clients treated in a rough manner or without dignity and respect. Other staff interviews conducted stated that they were told an incident that occurred with C1 but were not present during the incident.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20231019112245

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: NEWPORT INSTITUTE - BAYVIEW	FACILITY NUMBER: 216804061
	VISIT DATE: 01/12/2024

NARRATIVE

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Continued from LIC9099

Client interviews conducted stated they haven’t seen staff treat C1 in rough manner or without dignity and respect. Review of facility documentation dated 10/15/2023 stated that Staff found C1’s bathtub about to overflow with water. C1 then locked themselves in their bathroom and did not respond to staff when Staff called out C1’s name or asked for a reply. Staff informed C1 that if they continued to not respond, they would be treated as unresponsive, and staff would enter the bathroom. C1 was found to be doing their hair and remained verbally unresponsive to staff. C1 then went to their bed and was physically and verbally unresponsive to staff. Staff contacted Facility Supervisor and was instructed to ensure that C1 was breathing, let air into their room, and remove all items with cords from the area. C1 remained physically and verbally unresponsive to staff for the remainder of the shift. Due to conflicting information provided during interviews and record review, the LPA is unable to determine if a Title 22 Regulation violation occurred. Therefore, these allegations are Unsubstantiated.

A finding that the complaint is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Residential Supervisor. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC9099 (FAS) - (06/04)

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