565850215-3-19-2024-29-AS-MARO-D3HTSH-20240319145911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850215
Report Date: 03/19/2024
Date Signed: 03/19/2024 02:59:45 PM

Document Has Been Signed on 03/19/2024 02:59 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 -READ		FACILITY NUMBER:	565850215
ADMINISTRATOR:	STOKES, JEP		FACILITY TYPE:	772
ADDRESS:	4914 READ ROAD		TELEPHONE:	(805) 222-5110
CITY:	MOORPARK	STATE: CA	ZIP CODE:	93021
CAPACITY: 6		CENSUS: 5	DATE:	03/19/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Regan Mew		TIME COMPLETED:	03:10 PM

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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a one year required annual at 9:15 a.m. The last annual conducted at this facility was on 02/24/2023. Upon arrival, the LPA met the Administrator, Charles Jimenez and the reason for the visit was explained. The Compliance Specilaist, Regan Mew arrived during the inspection. Entrance interview.

At 9:26 a.m., the LPA along with the Administrator 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 noted:

During the inspection, there were eight (8) staff and five (5) clients. Clients were in the middle of a group session.

Kitchen: The kitchen/food area was observed at 9:43 a.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates and food labels had expiration date clearly marked. Knives and sharps were observed locked and inaccessible at the time of the visit.

Common Areas: At the time of the visit, treatment, therapy, and office furniture was observed to be in good condition. The LPA observed clients in common areas at the time of the inspection. Activities are both designed for both as individuals and as a group. The facility maintained a comfortable temperature. There are several fire extinguishers throughout the facility; they all were fully charged and were last serviced 07/08/2023.

Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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 -READ	FACILITY NUMBER: 565850215
	VISIT DATE: 03/19/2024

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The LPA observed required postings throughout the common space. At 10:12 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The last fire inspection was completed on 08/29/2023 and was found to be in compliance with Fire Code Regulations at the time of inspection. Fire and earthquake drills conducted quarterly as per regulation; the last one conducted 02/23/2024.

Laundry Room: There is a laundry room which is kept locked and inaccessible to clients. Clients do their own laundry with the assistance of staff. Cleaning supplies and disinfectants are stored in locked cabinets inaccessible to clients.

Backyard: The backyard has a shaded area equipped with furniture for client use. There are two gates on each side of the house designated for an emergency exits. The backyard is gated. Passageways were free and clear from obstruction. There are no bodies of water on the premises.

Restrooms: The three (3) client restrooms were clean and sanitary and in operating condition with non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured in all three (3) bathrooms and measured between 105- and 120-degrees Fahrenheit between 9:28 a.m. and 9:37 a.m.

Bedrooms: There are three (3) double occupancy client bedrooms. All three (3) bedrooms were furnished with appropriate linens and required furniture. Adequate lighting in all bedrooms was observed.

Records: The LPA reviewed client records at 10:46 a.m. and staff records at 11:52 a.m.

The LPA reviewed five (5) client files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, Consent for Treatment form, and current needs and services plan. All client files were in order.

The LPA reviewed seven (7) staff files 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.

Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

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 -READ	FACILITY NUMBER: 565850215
	VISIT DATE: 03/19/2024

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The LPA conducted one (1) staff interview at 10:35 a.m.

During today’s visit, LPA obtained copies of LIC 500, Client Roster, and Emergency Disaster Plan.

Medications: Medications review began at approximately 1:15 p.m.; medications are centrally stored and locked inside the Medication Room. All medications including PRNs were labeled, stored, and locked inaccessible to clients. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during medications review.

No deficiencies were noted at this time. Exit interview conducted. Report was reviewed and a copy was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024

LIC809 (FAS) - (06/04)

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