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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006158
Report Date: 10/06/2025
Date Signed: 10/06/2025 12:54:01 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-20250929123819
FACILITY NAME:NEWPORT INSTITUTE - MIRAMARFACILITY NUMBER:
306006158
ADMINISTRATOR:ALEXIS LEFACILITY TYPE:
772
ADDRESS:10022 MIRAMAR CIRCLETELEPHONE:
(714) 393-3523
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 6DATE:
10/06/2025
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Residential Supervisor Jenna OrtizTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility did not follow their plan of operation
INVESTIGATION FINDINGS:
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On October 6, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the allegation 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 six 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 #3 (C3). LPA additionally conducted one staff interview.

Regarding the allegation that, facility did not follow their plan of operation, the following has been concluded: LPA reviewed C3's face sheet and observed C3 was admitted to the facility on July 28, 2025 and was discharged from the facility on September 11, 2025. CONTINUED ON LIC9099-C
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
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 5
Control Number 22-AS-20250929123819
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 - MIRAMAR
FACILITY NUMBER: 306006158
VISIT DATE: 10/06/2025
NARRATIVE
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LPA reviewed the discharge summary for C3 dated September 11, 2025 and observed that 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. LPA conducted one staff interview who confirmed the discharge summary for C3 does not include the reason C3 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: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250929123819
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 - MIRAMAR
FACILITY NUMBER: 306006158
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2025
Section Cited
CCR
81022(j)
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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:
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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.
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Based on records reviewed, the Licensee did not ensure the facility following the plan of operation regarding the discharge summary for Client #3. This poses a potential health, safety, and personal rights risk to persons in care.
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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: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5