<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006157
Report Date: 10/01/2025
Date Signed: 10/01/2025 02:38:14 PM

Substantiated


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
09/29/2025 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250929125937
FACILITY NAME:NEWPORT INSTITUTE - PERIWINKLEFACILITY NUMBER:
306006157
ADMINISTRATOR:BRIANNA GRAHAMFACILITY TYPE:
772
ADDRESS:12822 PERIWINKLE DRIVETELEPHONE:
(714) 393-3523
CITY:NORTH TUSTINSTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 5DATE:
10/01/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Residential Supervisor Jenna OrtizTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Admission agreement was not signed in a timely manner
Facility is not following the plan of operation
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 1, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the allegations listed above and to deliver the findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Residential Supervisor (RS) Jenna Ortiz was notified via telephone and later arrived to assist with the inspection.

On today's visit, there are five clients in care. LPA, accompanied by the by the RS, conducted a tour of the physical plant. No health or safety concerns were observed. LPA collected pertinent documents to the complaint such as client records for Client #1 (C1), Client #2 (C2). LPA additionally conducted two staff interviews.

Regarding the allegation that, admission agreement was not signed in a timely manner, the following has been concluded: LPA reviewed the client records for C1 and C2. LPA observed there was no admission agreement on file for C1. CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
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 3
Control Number 22-AS-20250929125937
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: 10/01/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Two out of two staff interviews conducted confirmed there was no admission agreement on file for C2. Based on the evidence gathering during this investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Regarding the allegation that, facility is not following the plan of operation, the following has been concluded: LPA reviewed the discharge summary for C2 dated August 15, 2025, and the discharge summary for C3 dated August 8, 2025. LPA observed that in the discharge summary for C2, it does not state the reason C2 was discharged from the facility. LPA also observed that in the discharge summary for C3, it does not state the reason C3 was discharged from the facility. LPA reviewed the facility's plan of operation which states the discharge plan instructions. Per the facility's discharge plan instructions, there shall be a discharge summary for each client within twenty four hours of discharge and it shall include the reason the client was discharged from the facility. Based on the evidence gathering during this investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

An exit interview was conducted with Residential Supervisor Jenna Ortiz. A copy of the report and Appeal Rights were provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250929125937
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2025
Section Cited
CCR
81068(a)
1
2
3
4
5
6
7
81068 Admission Agreement: (a) The licensee shall complete an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement was not evidenced by:
1
2
3
4
5
6
7
The Residential Supervisor stated she will complete a written statement stating the facility will ensure that every client has a valid admission agreement on file. The Residential Supervisor agreed to provide the written statement to LPA via email or fax by POC date.
8
9
10
11
12
13
14
Based on interviews conducted and records reviewed, the Licensee did not ensure there was a valid admission agreement on file for Client #1. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
10/17/2025
Section Cited
CCR
81022(j)
1
2
3
4
5
6
7
81022 Plan of Operation: (j) The facility shall operate in accordance with the terms specified in the plan of operation and may be cited for not doing so.

This requirement is not evidenced by:
1
2
3
4
5
6
7
The Residential Supervisor stated she will complete a written statement that the facility will comply with their plan of operation. The Residential Supervisor agreed to provide the written statement to LPA via email or fax by POC date.
8
9
10
11
12
13
14
Based on records reviewed, the Licensee did not ensure the facility following the plan of operation regarding the discharge summary for Client #1 and Client #2. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
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: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3