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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881326
Report Date: 06/21/2023
Date Signed: 06/21/2023 01:59:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2023 and conducted by Evaluator Chinwe Nwogene
COMPLAINT CONTROL NUMBER: 18-AS-20230407093726
FACILITY NAME:NEWPORT INSTITUTE - SYCAMOREFACILITY NUMBER:
331881326
ADMINISTRATOR:DOKES, KENYOTAFACILITY TYPE:
772
ADDRESS:28190 SYCAMORE MESA ROADTELEPHONE:
(714) 393-3523
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY:6CENSUS: 2DATE:
06/21/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kenyota Dokes, Administrator
Michelle Hayes, Clinical Director		TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility license number is not revealed on all facility advertisements.
INVESTIGATION FINDINGS:
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On 6/21/2023, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with Administrator, Kenyota Dokes and Clinical Director, Michelle Hayes who was informed of the purpose of the visit. During the investigation staff and facility record was reviewed.
It was alleged Facility license number is not revealed on all facility advertisements. LPA interviewed staff who stated the advertisements are handled by the Newport Company. LPA interviewed the Newport Regional Licensing and Compliance Manager who acknowledged the License number wasn’t added in the advertisements when this complaint was received but has now been added. LPA reviewed Newport Company website at the time this complaint was received and observed no License number.
Based on LPA's observation, and interview, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) is being cited on the attached LIC 9099D). An exit interview was conducted, and a copy of this report was reviewed with and provided to Kenyota Dokes.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20230407093726
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 - SYCAMORE
FACILITY NUMBER: 331881326
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2023
Section Cited
CCR
81011(a)
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Advertisements and License Number;

Licensees shall reveal each facility license number in all advertisements in accordance with Health and Safety Code section 1514.
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Licensee provided screenshot of company's website that shows License number has been added in advertisements.
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This requirement is not met based as evidence by observation and interview. The licensee did not comply by not revealing the facility number on all advertisements which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2