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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850215
Report Date: 02/14/2022
Date Signed: 02/14/2022 01:27:59 PM

Document Has Been Signed on 02/14/2022 01:27 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 -READFACILITY NUMBER:
565850215
ADMINISTRATOR:STOKES, JEPFACILITY TYPE:
772
ADDRESS:4914 READ ROADTELEPHONE:
(805) 222-5110
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY: 6CENSUS: 0DATE:
02/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jep StokesTIME COMPLETED:
01:27 PM
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Licensing Program Analyst (LPA) JoAnn Rosales conducted a Pre-licensing visit at the facility. LPA met with Administrator Jeb Stokes, Residential Director Tone Reyes and Residential Supervisor Charles Jimenez. On 2/14/22 LPA received a letter from the Applicant Representative Joseph Procopio designating Jep Stokes as the Applicant Representative for the Prelicensing visit. Component III was completed in conjunction with today’s visit.

LPA inspected facility for Fire Safety, Personal Accommodations and Services, Medication Procedures, and Food Service. Facility has adequate linen and first aid supplies.

Facility has 3 shared client bedrooms and 1 shared client bathroom. The laundry supplies and equipment are kept in a laundry room. There is sufficient indoor and outdoor space for activities. Facility has 4 visitor/client bathrooms. The common areas were appropriately furnished and lighting was adequate. There is additional entertainment equipment and games for activities. The medications are kept in a locked medication room. Client records will be kept electronically. Staff records will be kept in an outside office location and also electronically. Hot water temperature tested at 110.5 degrees Fahrenheit during today’s visit. LPA observed hard wired smoke detectors and carbon monoxide detectors operating properly. LPA observed fire extinguishers properly charged.

The following needs to be completed/proof submitted prior to the facility being licensed:

1. Hand railing for stairs leading to second floor.

Continued on 809C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Joann Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2022
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 -READ
FACILITY NUMBER: 565850215
VISIT DATE: 02/14/2022
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2. 7 day supply of non-perishable fruit and vegetables.

3. Sufficient supply of tableware, dishes and utensils.

4. Flashlights and batteries.

5. Outdoor shaded area.

Exit interview conducted, today's report was reviewed and emailed to the Administrator.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Joann Rosales
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC809 (FAS) - (06/04)
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