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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006157
Report Date: 04/17/2023
Date Signed: 04/17/2023 10:26:48 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2023 and conducted by Evaluator Patricia Velazquez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230407091703
FACILITY NAME:NEWPORT INSTITUTE - PERIWINKLEFACILITY NUMBER:
306006157
ADMINISTRATOR:CONNOR, ANNEFACILITY TYPE:
772
ADDRESS:12822 PERIWINKLE DRIVETELEPHONE:
(714) 393-3523
CITY:NORTH TUSTINSTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 5DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH: Crystal Goodwin - Licensing and Compliance Manager TIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Facility license number is not revealed on all facility advertisements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to initiate an investigation into the above allegation. The visit was conducted at the corporate office located at 19200 Von Karman Suite 500 Irvine 92612. LPA Velazquez met with Licensing and Compliance Manager (LCM) Crystal Goodwin and explained the purpose of the visit.

On today's visit LPA Velazquez conducted an interview with LCM Goodwin. LPA Velazquez along with LCM Goodwin conducted a review of the facility's website and social media account Instagram. LPA Velazquez as well as LCM Goodwin did not observe the facility license number on any of these sites. During the course of the investigation the following was revealed: LPA Velazquez conducted an interview with LCM Goodwin. On April 12, 2023 LPA Velazquez conducted a review of the facility's website and Facebook account where the facility license number was not observed. The facility was licensed by the CA Department of Social Services on October 6, 2022.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 22-AS-20230407091703
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - PERIWINKLE
FACILITY NUMBER: 306006157
VISIT DATE: 04/17/2023
NARRATIVE
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Based on the observations of LPA Patricia Velazquez, interview which was conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility license number is not revealed on all facility advertisements is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 2 and/or the Health and Safety Code is being cited on the attached LIC 9099D.


An exit interview was conducted with Licensing and Compliance Manager Crystal Goodwin and a copy of this report along with the appeal rights and LIC 9098 were provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230407091703
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - PERIWINKLE
FACILITY NUMBER: 306006157
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
81011(a)
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Advertisements and License Number. Licensees shall reveal each facility license number in all advertisements in accordance with Health and Safety Code section 1514. This requirement is not met as
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Licensee to ensure the facility license number is posted on their website and all other advertisements pursuant to statute and regulation. Licensee to submit written proof of such by POC due date.
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evidenced by: based on interview and review of the facility's advertisements, the Licensee did not post the license as required. This poses a potential risk to the health and safety of clients in care.
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Licensee to submit a written statement indicating they have read this section of statute and regulation and how exactly they intend to adhere to it by POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Patricia Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3