565850253-6-22-2023-29-AS-KDUK-CT2V3R-20230622160510

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850253
Report Date: 06/22/2023
Date Signed: 06/22/2023 04:06:17 PM

Document Has Been Signed on 06/22/2023 04:06 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 - ALHAMBRA		FACILITY NUMBER:	565850253
ADMINISTRATOR:	HERNANDEZ, ALEXANDER		FACILITY TYPE:	772
ADDRESS:	2565 ALHAMBRA COURT		TELEPHONE:	(714) 393-3523
CITY:	SANTA ROSA VALLEY	STATE: CA	ZIP CODE:	93012
CAPACITY: 6		CENSUS: 5	DATE:	06/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Leopoldo (Leo) Vaca		TIME COMPLETED:	04:15 PM

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Annual Inspection at the facility today. LPA arrived at 11:55AM and met with facility Designee Leopoldo (Leo) Vaca. Entrance interview conducted.

LPA, along with facility Designee, toured the facility beginning at 11:56AM to ensure client health and safety and the facility is in compliance with Title 22 regulations. The following was observed:

COMMON AREAS: These include the Family Room, Dining Room, and garage gym. All furniture appeared clean and in good condition. A fireplace was observed in the family room to be adequately screened at the time of the visit. Fire extinguishers were observed throughout the common areas, and were observed to be fully charged and last serviced 07/20/2022.

TREATMENT/THERAPY, MEDICATION ROOM & OFFICE AREAS: There is a Group/Family Room, Family Therapy Room, Medication Room, and two (2) offices located on the ground floor. There is also a Learning Lab located on the second story as well as one (1) additional office. Medications are stored in a locked first floor Medication Room. The medication room has adequate locked storage, as well as a locked refrigerator. At 03:14PM, medications were reviewed for 2 (two) clients. Medications observed were properly labeled and medication records observed were documented per regulation. The First Aid Kit is stored in the Medication Room and was observed to be complete. The Offices are kept inaccessible to clients unless properly supervised.

LAUNDRY: Locked Laundry Room is located on the ground floor. Laundry and cleaning supplies were observed to be inside a locked closet in the locked laundry room.

KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient nonperishable food to accommodate clients for (seven) 7 days and perishable food for two (2) days. Designee indicated lunch Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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 - ALHAMBRA	FACILITY NUMBER: 565850253
	VISIT DATE: 06/22/2023

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and dinner are prepared off-site, at another of the licensee's facilities. LPA did not observe an approved waiver for off-site food preparation. Knives and other sharps are stored in a locked office, not in the kitchen. There were no visible immediate hazards observed.

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

BATHROOMS: There are five (5) Bathrooms, two (2) on the ground floor and three (3) on the second floor. The bathrooms located on the ground floor include a full bath attached to the office designated for client use and a half bath in the main hallway for staff use. The bathrooms located on the second floor are all full bathrooms and two (2) are designated for client use. 1 upstairs bathroom is designated for staff use only. All bathrooms were supplied with appropriate paper and hygiene products. At 12:03PM, water temperature in the upstairs client bathroom was measured at 151.8 degrees Fahrenheit. Water temperature was measured in the second upstairs client bathroom and also measured above the required range.

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, an in-ground swimming pool, as well as a stable and barn, and open space. The pool is kept inaccessible to clients with the use of fencing that includes a locked gate. Staff have received the appropriate Water Safety Certification and Designee stated that qualified staff are present at all times that the pool is in use by clients. No immediate hazards were observed during the visit.

STAFF/CLIENT FILE REVIEW: LPA reviewed 5 (five) staff records during today's visit. LPA reviewed 5 (five) client file records during the visit. All staff and client records reviewed were in compliance with Title 22 regulation at the time of the visit.

INFECTION CONTROL/DISASTER PREPAREDNESS: During today’s visit, the LPA reviewed the facility's infection control policy and disaster preparedness policies. All items reviewed were in compliance.

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

Pursuant to Title 22 Division 6 Chapter 2 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted with Facility Designee Leopoldo (Leo) Vaca. Today’s reports and appeal rights were reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/22/2023 04:06 PM - It Cannot Be Edited

Created By: Kelly Dulek On 06/22/2023 at 03:39 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: NEWPORT INSTITUTE - ALHAMBRA	FACILITY NUMBER: 565850253
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

81088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as water temperature was measured at 151.8 degrees Fahrenheit in the upstairs client restroom which poses an immediate health and safety risk to persons in care.
	POC Due Date: 07/05/2023
	Plan of Correction
1 2 3 4	Water temperature was turned down during today's visit. Designee will record water temperatures daily, measuring the temperature at varying times of the day for 7 days and submit the water temperature log to CCL by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Kristin Heffernan

LICENSING EVALUATOR NAME:

Kelly Dulek

LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC809 (FAS) - (06/04)

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