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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006059
Report Date: 10/05/2022
Date Signed: 10/05/2022 10:11:55 AM

Document Has Been Signed on 10/05/2022 10:11 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:NEWPORT INSTITUTE - CERRO VISTAFACILITY NUMBER:
306006059
ADMINISTRATOR:APOSTU, DIANAFACILITY TYPE:
772
ADDRESS:160 S. CERRO VISTA WAYTELEPHONE:
(714) 393-3523
CITY:ANAHEIMSTATE: CAZIP CODE:
92807
CAPACITY: 6CENSUS: 6DATE:
10/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cristen Riha and Diana ApostuTIME COMPLETED:
10:30 AM
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Licensing Program Analyst Michelle Reed arrived at the facility to conduct a Case Management visit. The visit was conducted to follow-up on an unusual incident report that was received in the Licensing Office on 8/2/22. Upon arrival, LPA met with Clinical Director Cristen Riiha. Administrator Diana “Dee” Apostu arrived at approximately 9:45am. There were 6 clients present at the time of visit.

On 7/31/22 at approximately 10:00 a.m. Client #1(C1) attempted to self harm by cutting her left upper arm with a metal fidget toy that was given to her by staff. Staff washed the wound and notified the nurse who was on site who performed wound care. The toy was immediately confiscated and disposed of. At approximately 1:30pm C1 was taken to Urgent Care where wound care was conducted and topical ointment provided. C1 returned to the facility at 2:30pm and a 1:1 was put into place. C1 discharged from facility on 9/10/22.

C1's medical assessment and care plan were reviewed.

No cited deficiencies issued at this time.

An exit interview was conducted and a copy of this report and appeal rights were provided to Diana Apostu.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2022
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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