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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006401
Report Date: 02/05/2025
Date Signed: 02/05/2025 11:02:28 AM

Document Has Been Signed on 02/05/2025 11:02 AM - 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:CLEARWATER NEWPORT BEACHFACILITY NUMBER:
306006401
ADMINISTRATOR/
DIRECTOR:		JOHNSTON, ROBERTFACILITY TYPE:
740
ADDRESS:101 BAYVIEW PLACETELEPHONE:
(949) 942-6391
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY: 120CENSUS: 57DATE:
02/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:59 AM
MET WITH:Zehra Syed-Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
11:16 AM
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr made an unannounced case management visit for the purpose of conducting a health and safety inspection. LPA was greeted and granted entry by Executive Director (ED) Zehra Syed. LPA explained the reason for the visit.

LPA conducted a case management visit to follow up on a death report dated January 27, 2025, for Resident 1 (R1).

LPA and ED conducted a toured of the facility and observed the facility has electricity, water, and gas. Water temperature tested at 114.4 degrees Fahrenheit. Resident bedrooms were observed to have the required furnishings. Certificate of liability insurance was observed to be current. The kitchen was observed to be clean and organized and a 2-day supply of perishable and a 7-day supply of non-perishable food was observed. Medications are kept locked in a cabinet in the Medication Room. Knives are kept locked in the kitchen. All and any toxic chemicals, cleaning solutions, laundry toxins, and disinfects were observed to be inaccessible to Residents.

During today's visit LPA observed as Residents were having breakfast and/or participating in their morning activities.

Based on observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided at the time of exit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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