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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006086
Report Date: 02/22/2022
Date Signed: 02/22/2022 01:30:55 PM

Document Has Been Signed on 02/22/2022 01:30 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 -LEWISFACILITY NUMBER:
306006086
ADMINISTRATOR:NONOSHITA, MATTHEWFACILITY TYPE:
772
ADDRESS:7251 E LEWIS AVETELEPHONE:
(714) 393-3523
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 6CENSUS: DATE:
02/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Matthew NonoshitaTIME COMPLETED:
01:39 PM
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Licensing Program Analysts (LPAs) Jerome Haley and Kevin Saborit-Guasch. Licensing Program Managers (LPMs) Luz Adams and Armando Lucero, and Regional Manager (RM) Marina Stanic arrived at the facility to conduct a Prelicensing visit. Upon arrival, staff met with Director Matthew Nonoshita, Compliance Manager Crystal Goodwin. The applicants have applied for a Social Rehabilitation Facility (SRF) and were approved by the Orange City Fire Department for 6 ambulatory residents. The facility is a two story structure with 4 bedrooms, 4 offices, and 5 bathrooms. There is a swimming pool on the premises that meet Title 22 regulation at this time. A tour of the physical plant was conducted inside and out and the following was observed:
The outdoor space has shading and outdoor furniture. Walkways inside and outside were clear of hazards and the exits were free of obstructions.
Hot water temperature in bathrooms was within regulation guidelines. Water temperature measured at 109.5 degrees F. All smoke detectors were hard wired and in operating condition. Fire extinguishers were present and charged.Poisons, toxic substances, and other dangerous objects were noted to be secured and inaccessible. There were toxins in the back yard shed that will be properly stored and organized. In addition to loose cement blocks that will be removed from the backyard area. For all corrections, facility staff has agreed to provide pictures to LPA once completed.

Sufficient hygiene and linen supplies were available. Client furnishings and equipment were present in the bedroom and bathrooms as well as sufficient lighting. Facility staff will add an additional chair and night stand in bedroom #1, and an additional night stand in bedroom #2.
Medications and resident records will be centrally stored in a medication room and not accessible to residents in care. First Aid kits and emergency supplies were also present. During this visit, the facility website was reviewed and in compliance.

The license will be granted upon completion of a final review and approval by management.
An exit interview was conducted, Component III was waived and a copy of this report was provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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