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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006059
Report Date: 01/09/2024
Date Signed: 01/09/2024 11:51:12 AM

Document Has Been Signed on 01/09/2024 11:51 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:
01/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ravon Hardy
Anne Connor
TIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted and granted entry by Staff Ravon Hardy. LPA discussed the purpose of the inspection and Program Manager (PM) Anne Connor was contacted by phone and arrived at 9:45 a.m. During the inspection LPA and staff conducted a tour of the inside and outside of the facility, common areas, client rooms, kitchen, garage and observed the following:

This is a two-story home with four client bedrooms, six bathrooms, three staff offices, one learning lab room, one dining room, one family room, one kitchen, one laundry room, one recreation room, one hallway storage closet, and two garages located on the first floor. The second story of the facility is located directly above the recreation room and contains two therapist offices. All client bedrooms had the required furnishings. LPA observed all client beds had linens and blankets. LPA observed all windows were screened. The backyard has a shaded sitting area, tennis court, and in-ground swimming pool. Pool was observed to fenced with a self-latching door. LPA observed two direct care staff and all six clients present. Clients were observed engaging in group therapy. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 105.2-113.9 F degrees. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted at the entrance of the facility. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed to be mounted and fully charged with a service tag indicating last service date was on 1/04/24. Stove burners, microwave, washer, and dryer were all inspected and tested operable. Sharps were observed locked in a kitchen drawer. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to clients. Medication is kept in a cabinet within the medication room, both medication cabinet and medication room were observed to be locked. LPA reviewed four client files and two staff files. LPA interviewed two staff and two clients.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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