<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804061
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:54:06 PM

Document Has Been Signed on 12/20/2022 12:54 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:NEWPORT INSTITUTE - BAYVIEWFACILITY NUMBER:
216804061
ADMINISTRATOR:KORELIN, SARAFACILITY TYPE:
772
ADDRESS:285 MARGARITA DRIVETELEPHONE:
(714) 393-3523
CITY:SAN RAFAELSTATE: CAZIP CODE:
94901
CAPACITY: 6CENSUS: 6DATE:
12/20/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Residential Supervisor Georgiamae Wallace and Program Director, Priscilla HernanadezTIME COMPLETED:
01:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At approximately 10:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Post-Licensing Inspection visit, and met with Residential Supervisor Georgiamae Wallace and Program Director, Priscilla Hernandez.

Upon arrival at the facility, LPA had their temperature checked and logged. LPA observed COVID-19 signs posted at the entry way and throughout the facility. Facility had sufficient amount of PPE available. All staff present were observed to be wearing a mask. Facility had a sufficient amount of perishable and nonperishable foods per regulation. Facility has an adequate supply of kitchen tools. Medications were observed to be locked and inaccessible to clients in care. There are two laundry areas with one area for Employee Use and the other for Client Use. Toxins and Detergents were observed to be locked and inaccessible to clients in care. LPA observed Client rooms to be furnished per regulation. Client bathrooms were supplied with paper towels, liquid hand soap, and hand-washing signs. Facility had an adequate supply of the following products available for clients: extra linens, grooming, hygiene, and paper products.

Facility has an Emergency Disaster Plan in place. Fire extinguishers were last serviced January 2022. Facility has a central fire alarm system that is directly connected to the Fire Department. The last Emergency/Fire Drill was conducted December 2022. Carbon Monoxide and Fire Detector alarms were last inspected December 2022.

During walkthrough, LPA observed 1 of 2 washing machines being out of order. Both machines were located in the Client designated laundry room. Per conversation with Residential Supervisor and Program Director, the machine has been broken for approximately 3 days and a ticket has already been submitted for service. The machine is expected to be operable within the week. Currently clients are utilizing the employee laundry room with staff supervision.
Continued on LIC 809C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/20/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC 809

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Program Director. Signature on form confirms receipt of documents.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2