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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006159
Report Date: 10/27/2023
Date Signed: 10/27/2023 02:39:15 PM

Unsubstantiated


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
10/20/2023 and conducted by Evaluator Andrea Mendivil
COMPLAINT CONTROL NUMBER: 22-AS-20231020140447

FACILITY NAME:NEWPORT INSTITUTE - DEERHAVENFACILITY NUMBER:
306006159
ADMINISTRATOR:CHAPMAN, KANANFACILITY TYPE:
772
ADDRESS:9881 DEERHAVEN DRIVETELEPHONE:
(714) 393-3523
CITY:NORTH TUSTINSTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 3DATE:
10/27/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sara Smith - Associate Clinical Director TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility did not complete the clients’ Needs and Services Plans
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Sara Smith, Associate Clinical Director and explained the reason for the visit.

During the course of the investigation LPA Mendivil obtained copies of client admission agreements and needs and services plan. LPA interviewed staff and clients. Regarding the allegation facility did not complete the clients needs and services plans, the investigation revealed the following:

LPA Mendivil reviewed 2 out of 3 client's needs and services plan. Per review of 2 out of 3 clients' needs and services plan both contain a written assessment that satisfies the requirements. Per review of both needs and services plan both were completed within 72 hours of each client's admission.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20231020140447
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 - DEERHAVEN
FACILITY NUMBER: 306006159
VISIT DATE: 10/27/2023
NARRATIVE
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 Due to conflicting information, LPA is unable to corroborate the allegations. Therefore, the allegation is deemed UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No deficiencies are being cited in today's visit.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4