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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850159
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:48:17 PM

Document Has Been Signed on 09/21/2022 01:48 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 - PRESILLAFACILITY NUMBER:
565850159
ADMINISTRATOR:STOKES, JEPFACILITY TYPE:
772
ADDRESS:11530 PRESILLA ROADTELEPHONE:
(805) 380-9041
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY: 6CENSUS: 6DATE:
09/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Estrella OzunaTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Annual Inspection at the facility today, with an emphasis on Infection Control practices and procedures. LPA arrived at 12:14PM and initially met with facility staff Estrella Ozuna. Entrance interview conducted. A tour of the physical plant was conducted with the facility staff Estrella Ozuna at 12:20PM and the following observed:

Fire extinguishers located throughout the facility were observed to be fully charged and last serviced on 07/26/2022.

KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient perishable and nonperishable food observed. Cleaning supplies are stored in locked under-sink cabinets. Knives and other sharps were observed to be inside a locked office. There were no visible immediate hazards observed.

BEDROOMS: There are three (3) Bedrooms, all of which are designated for client use. All bedrooms are located on the second story and furnished for double occupancy. All bedrooms were equipped and supplied with appropriate furniture, bedding and linens. There were no visible hazards or discrepancies observed.

BATHROOMS: There are six (6) Bathrooms, two (2) on the ground floor and four (4) on the second floor. The bathrooms located on the ground floor include a half bath in the main hallway for client use and a full bath attached to the office designated for staff use. The bathrooms located on the second floor are all full bathrooms and three (3) are designated for client use. 1 upstairs bathroom is designated for staff use only. All Bathrooms were supplied with appropriate soap and paper towels. Water temperatures were measured
in all client bathrooms and measured within the required range of 105 degrees F to 120 degrees F at the time of the visit. Report Continued on LIC 809-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 - PRESILLA
FACILITY NUMBER: 565850159
VISIT DATE: 09/21/2022
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COMMON AREAS: These include the Family Room, Dining Room, Gym//Recreation Room, and Laundry Room. The common areas were furnished appropriately and all furniture was observed to be in good condition. There is a fireplace in the Family Room, which was observed to be adequately screened. Locked Laundry Room is located on the ground floor. Laundry and cleaning supplies were observed in locked cabinets inside the locked Laundry Room. There were no immediate hazards observed.

TREATMENT/THERAPY, MEDICATION ROOM & OFFICE AREAS: There is a Group/Family Room, a Work Lab and an Office located on the ground floor. There is also a Family Therapy Room located on the second story, as well as an individual therapy office and 2 additional offices. Medications are stored in a locked second floor Medication Room. The medication room has adequate locked storage, as well as a locked refrigerator. The 1st Aid Kit is stored in the Medication Room. The Offices are kept inaccessible to clients unless properly supervised.

SURROUNDING GROUNDS: The Front Yard includes a driveway, paved walkways and landscaped areas. The backyard is fenced and includes both paved and landscaped areas, a patio, furniture appropriate for outdoor use, shade and an in-ground swimming pool. The pool is kept inaccessible to clients with the use of fencing that includes a locked gate, as well as a safety net. Facility staff indicated clients use the pool on the weekends, when properly supervised. There were no visible immediate hazards or deficiencies.

INFECTION CONTROL: During today's visit, LPA spoke with facility staff regarding the facility's infection control policies and procedures. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate.

The following recommendation was made:
- N95 fit testing for all staff

No deficiencies cited. Exit interview conducted with facility Designee Leopoldo (Leo) Vaca. A copy of the report was provided via email.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC809 (FAS) - (06/04)
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