306006158-10-6-2025-22-AS-BLOZ-DM7QKT-20251006121452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006158
Report Date: 10/06/2025
Date Signed: 10/06/2025 12:15:54 PM

Document Has Been Signed on 10/06/2025 12:15 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	NEWPORT INSTITUTE - MIRAMAR		FACILITY NUMBER:	306006158
ADMINISTRATOR/ DIRECTOR:	ALEXIS LE		FACILITY TYPE:	772
ADDRESS:	10022 MIRAMAR CIRCLE		TELEPHONE:	(714) 393-3523
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY: 6		CENSUS: 6	DATE:	10/06/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Residential Supervisor Jenna Ortiz		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

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	On October 6, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. 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. The facility is a Social Rehabilitation Facility (SRF) licensed for six ambulatory clients. The facility is a two story home with three shared client bedrooms, five bathrooms, a living room, a dining room, a kitchen, four staff offices, a family room, a medication room, a laundry room, and an attached three car garage. LPA, accompanied by the RS, conducted a tour of the interior portions of the facility. On today's visit, LPA observed six clients in care. LPA observed clients relaxing in their respective bedrooms and participating in therapy sessions. LPA inspected the three shared client bedrooms and observed them to be free of hazards. LPA observed client bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed client beds to have clean linens and blankets. LPA observed additional linens to be stored in the laundry room and in a hallway cabinet. LPA inspected the client bathrooms and observed them to be clean. Faucets and toilets were operational. Hot water temperature measured between 119.6 and 119.8 degrees Fahrenheit. LPA observed the kitchen has a two day perishable and a seven day non-perishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed the nine burner gas stove lights unassisted. LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed the facility also has a separate three day emergency food and water supply stored in a cabinet in the kitchen. CONTINUED ON LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST 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.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 observed the facility has a total of ten fire extinguishers that are mounted on the walls across the facility including in the kitchen, staff office, and client hallways. LPA observed fire extinguishers to be charged and serviced as of January 2, 2025. LPA observed the facility passed their most recent fire inspection conducted by the Orange County Fire Authority on February 5, 2025. The fire inspection consisted of testing the facility's smoke detectors/carbon monoxide detectors which tested operational. LPA observed the facility conducted their most recent emergency disaster drill on September 8, 2025.

LPA observed the centrally stored medication to be kept in a locked cabinet located inside a locked medication room on the second floor. LPA observed the facility has a First Aid Kit stored in the medication room and it has all the required components. LPA inspected all other common areas such as the staff offices, family room, laundry room, living room, dining room, the attached three car garage, and observed them to be clear of any hazards. LPA also observed the facility has an emergency evacuation chair located on the second floor by the staircase.

LPA, accompanied by the RS, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for client use. LPA observed the perimeter gates of the facility to be self latching and can be opened in an evacuation. There is a pool located in the backyard which was observed to be adequately fenced and kept locked for client safety.

LPA reviewed all six client files. All the required documentation were present and current in the client file reviewed. LPA reviewed the clients' medication and medication records. LPA reviewed five staff files. The facility was unable to provide the complete personnel record for Staff #4 (S4) during the visit. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809-D. An exit interview was conducted with Residential Supervisor Jenna Ortiz. A copy of the report and Appeal Rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST 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

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2025 12:15 PM - It Cannot Be Edited

Created By: Brandon Lopez On 10/06/2025 at 11:59 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

81066(g)(1)

81066 Personnel Records: (g) All personnel records shall be maintained at the facility site. (1) The licensee shall be permitted to retain such records in a central administrative location provided that they are readily available to the licensing agency at the facility site as specified in Section 81066(e). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. The facility was unable to provide the complete personnel record for Staff #4 (S4) during the visit.
	POC Due Date: 10/24/2025
	Plan of Correction
1 2 3 4	The Residential Supervisor stated that she will provide the complete personnel records for S4 via email to LPA to review. The Residential Supervisor stated they will also create a written plan to ensure complete personnel records are readily available for review by Community Care Licensing during visits.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:

	Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST 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

LIC809 (FAS) - (06/04)

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