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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850157
Report Date: 02/10/2025
Date Signed: 02/10/2025 03:48:52 PM

Document Has Been Signed on 02/10/2025 03:48 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:NEWPORT INSTITUTE - PIMLICOFACILITY NUMBER:
565850157
ADMINISTRATOR/
DIRECTOR:		JIMENEZ, CHARLESFACILITY TYPE:
772
ADDRESS:10813 PIMLICO DRIVETELEPHONE:
(805) 523-2294
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY: 6CENSUS: 6DATE:
02/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Inguilber Alcantar, House Supervisor & Regan Meruer, Compliance SpecialistTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Zabel Chochian conducted an unannounced Case Management - Incident visit at the facility today. The LPA met with House Supervisor Inguiber Alcantar.

The purpose of today's visit was to conduct interview with current clients, review records and obtain pertinent copies of facility records pertaining to a self reported incident pertaining to a former client (C1) of this facility.
During today's visit LPA toured the facility with the Program Supervisor at approximately 12:45pm; met with and conducted interview with four (4) out of six (6) clients from approximately 1:30pm-2:15pm. Following client interviews LPA met with the facility's Compliance Specialist Regan Merure and reason for LPAs visit was discussed. C1's records reviewed from 2:45pm-3:15pm; copy of C1's records provided. LPA also requested to view staff #1 (S1) records. LPA was informed that the staff records are online and may be produced via email to LPA upon LPA's written request via email. LPA sent an email requesting to view S1's file. LPA was provided a copy of S1's file at approximately 2:56pm.

LPA informed Ms. Merure that this incident case was referred to Community Care Licensing Division's (CCLD) Investigation Branch (IB) for further investigation and was accepted on 02/10/2025.

Further investigation is needed. The investigation is assigned to Investigator Sonia Torre.

LPA will return at a later date to issue investigation finding. Exit interview held. Copy of report provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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