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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881304
Report Date: 09/11/2024
Date Signed: 09/11/2024 02:50:25 PM

Document Has Been Signed on 09/11/2024 02:50 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NEWPORT INSTITUTE -PATAGONIAFACILITY NUMBER:
331881304
ADMINISTRATOR/
DIRECTOR:
SEIFSNYDER, RYANFACILITY TYPE:
772
ADDRESS:39650 PATAGONIA COURTTELEPHONE:
(714) 393-3523
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 6CENSUS: 6DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator, Ron SelixTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 9/11/2024, Licensing Program Analysts (LPAs) Janette Romero and Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Administrator, Ron Selix who was informed of the purpose of the visit. The facility has a fire clearance for six (6) ambulatory clients.

LPAs toured the facility and reviewed records. During the tour, LPAs observed the facility is made up of a two (2) story home with a basement, three (3) client bedrooms, five (5) client bathrooms, a living room, dining room and several offices and rooms designated for activities. Administrator Selix tested one (1) of the smoke alarms/carbon monoxide detectors and LPAs observed it to be operational. LPAs also observed several charged fire extinguishers mounted throughout the facility. Medications are secured in a locked cabinet stored in the medical room.

All client bedrooms had the required furniture and lighting. LPAs observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. LPAs observed a room with additional clean towels, blankets, and linen, available for the clients. LPAs toured the kitchen and observed the facility has a 2-day supply of perishable foods and more than a 7-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPAs observed knives and sharp instruments secured in locked kitchen cabinet. Cleaning solutions and disinfectants are secured in a locked closet cabinet near the laundry room. LPAs reviewed random client files, which had care plans and signed admission agreements. Administrator reported that the facility's last fire drill was conducted on 07/22/24.

During today's visit, LPAs did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Selix.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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