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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006059
Report Date: 11/01/2022
Date Signed: 11/01/2022 01:01:17 PM

Document Has Been Signed on 11/01/2022 01:01 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, 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:
11/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Anne ConnorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection in this facility. LPA met with staff and stated the purpose of this visit. Administrator was not able to make the visit.

The facility is a two-level structure and licensed for six ambulatory clients. This facility is a Long-Term Residential Program.

At about 11:46 am, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed clients and staff on duty during the inspection of the facility. LPA toured the interior and exterior portions of the facility. The facility had a medication room, learning room, gym and recreational room. There were 4 client rooms, 2 of which were shared rooms. Client rooms were located on the first floor of the facility. The second floor of the facility is for staff only. Client rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Laundry room was equipped with an operational washer and dryer. A report was provided with manual smoke detectors and carbon monoxide alarms last tested on 3/29/2022. Bathrooms were observed to be in good repair and hot water was measured at 105.9 degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements. Facility had adequate supplies of personal protective equipment in place. Fire extinguishers were observed mounted.

For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. The exterior portion of the facility contained a swimming pool with a gate surrounding the pool and a locked latched door. Facility also contained a basketball court and tennis court. Garage is kept locked and used for storage, an extra refrigerator and a car. Kitchen was in good repair with medications and sharp items kept locked. LPA Tapia reviewed the COVID 19 mitigation plan and the Emergency Disaster plan of the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 VISTA
FACILITY NUMBER: 306006059
VISIT DATE: 11/01/2022
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For this visit, no deficiency was noted in areas observed.

LPA Tapia conducted an exit interview with staff and copy of this report was explained and left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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