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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881326
Report Date: 11/27/2024
Date Signed: 11/27/2024 10:37:21 AM

Document Has Been Signed on 11/27/2024 10:37 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NEWPORT INSTITUTE - SYCAMOREFACILITY NUMBER:
331881326
ADMINISTRATOR/
DIRECTOR:		DOKES, KENYOTAFACILITY TYPE:
772
ADDRESS:28190 SYCAMORE MESA ROADTELEPHONE:
(714) 393-3523
CITY:TEMECULASTATE: CAZIP CODE:
92590
CAPACITY: 6CENSUS: 4DATE:
11/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator, Kenyota DokesTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On 11/27/2024, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Residential Supervisor (RS), Cheyenne Tracy who was informed of the purpose of the visit. Administrator, Kenyota Dokes arrived during the visit. The facility has a fire clearance for six (6) ambulatory clients.

LPA toured the facility's interior and exterior with RS Tracy. During the tour, LPA observed the facility is made up of a two-story home with three (3) client bedrooms, seven (7) bathrooms, a kitchen, living room, dining room, several staff offices, activity rooms, and an attached garage. The facility has an in-ground pool and spa located in the backyard that is secured with a locked fence. Indoor and outdoor pathways were free of obstructions. Outdoor shaded seating is available for the clients in care. LPA toured the kitchen and observed the facility has more than a two-day supply of perishable foods and a seven-day supply of non-perishable foods, which are stored in a safe and healthful manner. LPA observed knives and sharp instruments secured in a locked kitchen cabinet. Medications are secured in a locked cabinet inside the medication room upstairs. Facility Technician, Gavin Meyer tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed several charged fire extinguishers mounted throughout the facility that were last serviced on 1/16/2024. LPA observed a room with additional clean towels, blankets, and linen, available for the clients. Cleaning solutions and disinfectants are secured in a locked cabinet in the garage. All client files had updated needs and services plans and signed admission agreements. RS Tracy reported the facility's last fire drill was conducted on 11/20/2024.

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

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2024
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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