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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850157
Report Date: 05/15/2024
Date Signed: 05/15/2024 12:37:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/02/2023 and conducted by Evaluator Brian Balisi
COMPLAINT CONTROL NUMBER: 29-AS-20231002091242
FACILITY NAME:NEWPORT INSTITUTE - PIMLICOFACILITY NUMBER:
565850157
ADMINISTRATOR:STOKES, JEPFACILITY TYPE:
772
ADDRESS:10813 PIMLICO DRIVETELEPHONE:
(805) 523-2294
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY:6CENSUS: 4DATE:
05/15/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Inguilber "Ingi" Alcantar - Residential SupervisorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff does not meet qualifications to treat residents for therapeutic services.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Brian Balisi conducted a subsequent complaint visit to the above facility with the purpose of delivering findings for the above allegation. The initial complaint visit was conducted on 10/05/2023 by LPA M. Arroyo. On today’s visit, LPA Balisi met with Residential Supervisor Inguilber "Ingi" Alcantar and explained the reason for the visit.

During the initial visit on 10/05/2023, LPA M. Arroyo conducted interviews with four (4) staff members and two (2) client between 4:00 p.m. and 4:20 p.m. and obtained copies of pertinent documents relevant to the investigation.

It was alleged that staff does not meet qualifications to treat residents for therapeutic services. It was alleged that facility staff do not have the proper training required in order to provide specific services at the facility. Information obtained and reviewed revealed that Staff #1 (S1) has been working at the facility since 07/31/2021.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
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 3
Control Number 29-AS-20231002091242
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: NEWPORT INSTITUTE - PIMLICO
FACILITY NUMBER: 565850157
VISIT DATE: 05/15/2024
NARRATIVE
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Continued from 9099

Interviews conducted with staff revealed that therapeutic sessions with clients are typically done with two (2) different staff members, and one (1) of them being S1. Additionally, staff stated that Eye Movement Desensitization and Reprocessing (EMDR) is performed on at least two (2) clients at the facility by S1. Interviews conducted with clients revealed that they have had individual therapy with S1 including EMDR. Clients added that at different times they are able to get two (2) sessions of EMDR with S1 in one (1) week and stated that sessions were private with no one else in the room. However, in order to be able to practice therapy in the state of California, the staff/person is required to be licensed by the Board of Behavioral Sciences (BBS). Record review of BBS website revealed that S1 did not have a current license with BBS at the time of the complaint. Additionally, S1 did not obtain their BBS license until 11/30/2023, more than two (2) years after being hired, but meanwhile was practicing therapeutic services with clients without a license. Furthermore, the information obtained during interviews with both staff and clients corroborate the allegation and indicate that S1 was providing therapeutic services to clients prior to obtaining their license from BBS. Based on all information gathered during the course of the investigation, the above allegation, “staff does not meet qualifications to treat residents for therapeutic services” is deemed Substantiated at this time.

The following deficiency was observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code.

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 29-AS-20231002091242
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: NEWPORT INSTITUTE - PIMLICO
FACILITY NUMBER: 565850157
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
81065(p)
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(p) The licensee shall ensure that a direct service to a client shall be provided by a person with the appropriate license or certificate when required by law.
This requirement was not met as evidence by:
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S1 is licensed under BBS. POC has been met.
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Based on records review and interviews conducted the licensee did not comply with the section cited above as S1 was performing therapeutic services prior to obtaining their license with BBS on 11/30/2023, which poses a potential health and safety 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: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3