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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881305
Report Date: 01/31/2024
Date Signed: 01/31/2024 12:38:39 PM

Document Has Been Signed on 01/31/2024 12:38 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- SHADY CREEKFACILITY NUMBER:
331881305
ADMINISTRATOR:LIPPELGOOS, SABRINAFACILITY TYPE:
772
ADDRESS:43821 SHADY CREEKTELEPHONE:
(714) 393-3523
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY: 6CENSUS: 6DATE:
01/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Sabrina Lippelgoos - AdministratorTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation for a complaint (#18-AS-20240122155309). Prior to arriving at the facility today, LPA Colvin conducted a review of the facility's status and observed that the Licensee is behind in paying their annual fees. As of today's date, the Licensee owes $908.00 for annual fees for 2023, as well as subsequent late fees. Due to this being the facility's first year of annual fees being due, LPA Colvin is issuing a Technical Violation in lieu of a deficiency. Director Lauren Larkin was advised to have the Licensee pay the outstanding fees right away to avoid a future deficiency for non-compliance.

An exit interview was conducted and a copy of this report and LIC9102-TV was provided to Administrator Sabrina Lippelgoos.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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