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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004278
Report Date: 11/07/2024
Date Signed: 11/07/2024 12:25:47 PM

Document Has Been Signed on 11/07/2024 12:25 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NEWPORT SENIOR LIVING IIFACILITY NUMBER:
306004278
ADMINISTRATOR/
DIRECTOR:
BRUCE A. WINSTEADFACILITY TYPE:
740
ADDRESS:260 E. 16TH STREETTELEPHONE:
(949) 650-2222
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Deanna LandonTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Deanna Landson and explained the reason for the visit. The facility is a single story house with 7 bedrooms (6 resident rooms, 1 room used for storage), 4 bathrooms, kitchen, great room. Facility is licensed for a capacity of 6 non-ambulatory residents and hospice waiver for 4. LPA observed the See Something, Say Something poster (PUB 475) posted next the front door. LPA and the Administrator toured the facility. LPA observed the kitchen is clean and organized. Knives are kept locked in a kitchen drawer. LPA observed cleaning supplies are kept locked under the kitchen sink. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed medications are kept locked in a hall closet. LPA observed all fire extinguishers are fully charged. Smoke detectors/carbon monoxide detectors tested operational. LPA observed all resident rooms had the required furnishings and bed linens. LPA observed all 6 residents had bed rails. All 6 residents had a prescription for bed rails. LPA observed all 4 bathrooms are clean and operational. Hot water measured 119.8 degrees Fahrenheit in the shared bathroom next to the main entrance. LPA toured the backyard. There is a detached garage with a bathroom that has been converted into a living unit. The backyard has a gazebo and a table with an umbrella and chairs for residents to sit outside. No obstacles or hazards observed in the backyard. No bodies of water observed. There is no exit gate, the backyard has a clear path to the front yard. The front yard has a fence with a gate. There is a fountain in the front yard. The Administrator reported that a staff member lives on site there. LPA toured the building. LPA reviewed 6 resident files and medications, no discrepancies observed. LPA reviewed 2 staff files. No discrepancies observed. Both staff members are background cleared and associated to the facility. The last fire drill was conduced on October 28, 2024. LPA observed and the Administrator verified there is no dedicated internet device for resident use. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
Sheila SantosTELEPHONE: (714) 334-2062
Joseph AlejandreTELEPHONE: 714-705-6018
DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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