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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 216804061
Report Date: 01/31/2023
Date Signed: 01/31/2023 11:48:51 AM

Document Has Been Signed on 01/31/2023 11:48 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
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:
01/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Residential Supervisor, GeorgiaMae WallaceTIME COMPLETED:
12:00 PM
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At approximately 9:25AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Other visit, and met with Staff Member, Jackie Banda. Residential Supervisor, GeorgiaMae Wallace, arrived later during visit at approximately 9:45AM. Program Director, Priscilla Hernandez arrived at approximately 10:15AM.

LPA. Residential Supervisor, and Program Director discussed the following:
  • Food Safety
  • Covid Protocols
  • Incident Reporting


LPA cleared the deficiency cited on 12/2/2022 regarding food service.

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: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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