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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850159
Report Date: 09/05/2024
Date Signed: 09/05/2024 03:18:32 PM

Document Has Been Signed on 09/05/2024 03:18 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/
DIRECTOR:		ERIKA ANDRADEFACILITY TYPE:
772
ADDRESS:11530 PRESILLA ROADTELEPHONE:
(805) 380-9041
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY: 6CENSUS: 5DATE:
09/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Ahtziri Martinez TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a one year required annual visit at 9:45AM. Upon arrival, there were seven (7) staff and five (5) clients. LPA was greeted by facility staff who contacted the Residential Manager via telephone. The Residential Manager, Ahtziri Martinez arrived at 10:20AM. The Compliance Specialist, Regan Mew arrived during the inspection. Entrance interview.

At 10:25AM, the LPA along with the Residential Manager toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

BEDROOMS: There are three (3) client bedrooms. Client bedrooms are designated for double occupancy and located in the second floor. LPA observed all client bedrooms to be properly furnished with a bed, nightstand, and sufficient lighting. The bedrooms had appropriate and adequate bedding and linens such. There is a locked closet with client’s personal hygiene items.



BATHROOMS: There are six (6) total bathrooms in the facility. Four (4) bathrooms are designated for client use only. One (1) bathroom is located in the first floor; and three (3) bathrooms are located in the second floor. LPA observed bathrooms to be clean, properly supplied and had functional fixtures. Starting at 10:31AM, the water temperature was measured in all client bathrooms, and they measured between 105- and 120-degrees Fahrenheit at the time of the visit. There are two (2) staff bathrooms; one located in the first floor; and the other in the second floor.

Report Continued on LIC 809C...
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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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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: 09/05/2024
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Report Continued from LIC 809...

KITCHEN: The facility is utilizing an off-site kitchen for food preparation. The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply non-perishable and perishable food; properly stored. Refrigerator and dry food pantry were checked for proper labels and expiration dates and food labels had expiration dates clearly marked. Cleaning supplies are stored locked and inaccessible under the kitchen sink. Knives and other sharps were observed to be inside a locked office.

COMMON AREAS: These include the Family Room, Dining Room, Gym//Recreation Room, Laundry Room, Group/Family Room, a Work Lab and an Office. 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. Laundry Room is located on the first floor and observed locked at the time of the visit. Laundry and cleaning supplies were observed in locked cabinets inside the Laundry Room. There is also a Therapy Room located on the second floor, as well as an individual therapy office and 2 additional offices. The Offices are kept inaccessible to clients unless properly supervised. No obstructions or hazards were observed inside or out.



OUTDOOR / BACKYARD: The backyard is fenced with a shaded patio area with furniture appropriate for outdoor use. LPA observed an in-ground pool which was locked and inaccessible to clients at the time of the visit. Facility staff indicated clients use the pool on the weekends, when properly supervised. There are two (2) gates that self-latch for emergency use. The exterior passageways were clean and clear of any obstructions.

Report Continued on LIC 809C...
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
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: 09/05/2024
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Report Continued from LIC 809C...

RECORDS REVIEW: The LPA reviewed client records at 11:09AM and staff records at 12:05PM.

Five (5) client files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and treatment/rehabilitation plan. All client files were in order.

Six (6) staff files were reviewed for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification and yearly training. All files were complete.



INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. There are several fire extinguishers throughout the facility; they all were fully charged and were last serviced 04/29/2024. Carbon monoxide detectors are wired and operational at the time of the visit. The last fire safety inspection was completed on 08/04/2024 and sprinkler system inspection on 04/29/2024; both were found to be in compliance with Fire Code Regulations at the time of inspections. Emergency disaster drills conducted quarterly as per regulation; the last one conducted 08/05/2024.

MEDICATION REVIEW: LPA conducted a medication review at approximately 12:50PM. Medications are stored in a locked Medication Room on the second floor. The medication room has adequate locked storage, as well as a locked refrigerator. The 1st Aid Kit was observed to be complete inside the Medication Room. All medications reviewed were stored and documented per regulation.

INTERVIEWS: During today's visit, LPA interviewed two (2) staff.

No citations issued. Exit interview conducted. Report was reviewed and a copy was issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
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