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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006157
Report Date: 04/15/2025
Date Signed: 04/15/2025 03:03:20 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
05/10/2023 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20230510111529
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: 6DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Brie GrahamTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Insufficient staffing to meet residents' needs
Staff failed to administer residents' medication as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Fred Arias and Licensing Program Manager (LPM) Alisa Ortiz conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA and LPM were greeted and granted entry into the facility and explained the reason for the visit.

It was alleged insufficient staffing to meet residents' needs and staff failed to administer residents' medication as prescribed. During the investigation LPA conducted interviews with clients in care and staff. LPA reviewed client records, medication administration records, and observed client medications.

The investigation determined as follows: regarding the allegation of insufficient staffing to meet residents' needs, six out of six clients were interviewed by LPA and LPM. Four out of six stated staffing was sufficient to meet their needs. Two out of six clients stated although they felt their needs were being met however, there are times they wish there were more staff present.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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 2
Control Number 22-AS-20230510111529
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NEWPORT INSTITUTE - PERIWINKLE
FACILITY NUMBER: 306006157
VISIT DATE: 04/15/2025
NARRATIVE
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LPA reviewed LIC500 (Personnel Report) and the facility has 11 care coordinators alternating coverage 24/7. In addition to the care coordinators, there are clinical staff including therapists, nurses, and counselors that work throughout the week. At 8:05am, LPA observed three care coordinators at the facility providing services to their clients. In addition, the Residential Supervisor was present during the visit. Six staff members were interviewed for this allegation. Four out of six staff members stated at this time, there is sufficient staff coverage to support clients in care. However, four out of six staff members stated they wish there was more staffing available. Two out of the four stated the facility leadership has attempted to address their concerns and has provided additional staffing as needed. The remaining two out of six stated they felt there was insufficient staffing to meet the clients' needs. Therefore based on resident interviews, staff interviews, records observed, and LPA observations, the allegation facility has insufficient staffing to meet clients' needs is therefore deemed unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Regarding the allegation of staff failed to administer residents' medication as prescribed, six out of six clients were interviewed by LPA and LPM. Six out of six clients stated medication is administered on a regular scheduled basis. Four staff members were interviewed for this allegation. Four out of four staff members stated that medications are administered per schedule and are documented. LPA reviewed client medication records for six out of six clients and observed medications for 2 out of 6 clients. LPA observed medications were being given as prescribed. Therefore based on resident interviews, staff interviews, records observed, and LPA observations, the allegation of staff failed to administer residents' medication as prescribed is therefore deemed unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Atn exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2