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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850159
Report Date: 09/04/2025
Date Signed: 09/05/2025 07:58:14 AM

Document Has Been Signed on 09/05/2025 07:58 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:NEWPORT INSTITUTE - PRESILLAFACILITY NUMBER:
565850159
ADMINISTRATOR/
DIRECTOR:		VACA, LEOPOLDOFACILITY TYPE:
772
ADDRESS:11530 PRESILLA ROADTELEPHONE:
(805) 380-9041
CITY:CAMARILLOSTATE: CAZIP CODE:
93012
CAPACITY: 6CENSUS: 5DATE:
09/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Teresa Cardenas and Regan MewTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Valeria Conway arrived at the facility unannounced to conduct a one year required annual visit at 9:40 A.M. Upon arrival, there were seven (7) staff and five (5) clients. LPA met with Residential Supervisor – interim (RS), Teresa Cardenas, who contacted the Compliance Specialist, Regan Mew via telephone. The Compliance Specialist arrived during the inspection and will be signing today’s report. Entrance interview.

At 9:50 A.M., the LPA along with the RS 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. This facility doesn’t have a staff room, facility will provide 24/7 care. The following was observed:



BEDROOMS: There are three (3) client bedrooms. Client bedrooms are designated for double occupancy and located on 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.

BATHROOMS: There are six (6) total bathrooms in the facility. Four (4) bathrooms are designated for client use only. One (1) half bath is located on the first floor. The remaining three (3) are located inside each client’s room on the second floor. In addition, there are two (2) locked bathrooms for staff use only; one located on the first floor; and the other on the second floor. LPA observed bathrooms to be clean, properly supplied and had functional fixtures. Starting at 9:55 A.M., the hot water temperature was measured in all client bathrooms, and they measured between 105- and 120-degrees Fahrenheit at the time of the visit.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: NEWPORT INSTITUTE - PRESILLA
FACILITY NUMBER: 565850159
VISIT DATE: 09/04/2025
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Continued from LIC 809

KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of 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. At 10:14 A.M. hot water temperature measured 114.5 degrees Fahrenheit.

COMMON AREAS: These include the Family Room, Dining Room, Gym/Recreation Room, Laundry Room, Group/Family Room, a Work Lab and an office on the first floor and a therapy room, an individual therapy office and two (2) additional offices located on the second floor. Additionally, LPA observed a locked closet with client’s personal hygiene items. 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. During today’s visit LPA observed walls being repainted. LPA advised RS to notify the Department of any projects being conducted while clients are in care. RS acknowledged the directive. The 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. The Offices are kept inaccessible to clients unless properly supervised. No obstructions or hazards were observed inside or out. LPA observed an evacuation chair readily accessible for client use, located at the top of the stairway.

OUTDOOR / BACKYARD: The backyard is fenced with a shaded patio area with furniture appropriate for outdoor use. LPA observed an empty water fountain and an in-ground pool which was fenced, 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.

MEDICATION REVIEW: LPA conducted a medication review at approximately 11:30 A.M. 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 appeared to be documented per regulation.

Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: NEWPORT INSTITUTE - PRESILLA
FACILITY NUMBER: 565850159
VISIT DATE: 09/04/2025
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Continued from LIC 809-C

RECORDS REVIEW: At 1:23 P.M. the LPA reviewed client and staff records. The facility keeps all records online. 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 client files were in order.

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 02/24/2025. Carbon monoxide detectors are hardwired smoke alarms were operational at the time of the visit. The last fire safety inspection and sprinkler system inspection 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 06/19/2025.

No citations issued. Exit interview conducted. Report was reviewed and a copy was issued.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Valeria Conway
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
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