summary: Facility Evaluation

raw_content:
Narrative:
On July 7, 2022 at 11:26am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual Continuation of the Required Two-Year Annual inspection that began on 06/29/2022. LPA met with Residential Supervisor Rylee Kaczynski. During the inspection, LPA reviewed client files. A sample of six client files were reviewed during the inspection. All client files had the required documents per Title Regulations. All client files are maintained on a secured internet database. LPA discussed and reviewed the following inspection components; Operations, Emergency Intervention Plans, and Emergency Disaster Preparedness. During the inspection, interviews were conducted with five children. Based on the facility inspection, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained to Residential Supervisor Rylee Kaczynski. Due to printer malfunction, this report will be emailed to Residential Supervisor Rylee Kaczynski.

met_with: Rylee Kaczynski


state: CA

facility_name: NEWPORT ACADEMY

summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2022, at 2:47pm, Licensing Program Analyst (LPA) Adrian Mendez conducted an inspection with the facility for the purposes of initiating a complaint investigation. LPA met with Residential Supervisor Monica Garcia, and conducted a safety inspection of the facility. During the inspection it was confirmed that the incident surrounding the allegations occurred at a different facility location. No deficiencies were observed. An exit interview was conducted and this report was explained to Residential Supervisor Monica Garcia. Due to printer malfunction, this report will be emailed to Residential Supervisor Monica Garcia.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Monica Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On February 19, 2005 at 10:15am, Licensing Program Analyst (LPA) Gilbert Marquez conducted an inspection with the facility for the purposes of doing an annual inspection. LPA Marquez met with Program Manager Monica Garcia, and conducted a full plant inspection of the facility buildings and grounds. The census is 0 and there were no youths who were residing on the premises.According to Joe Viccaro, Executive Director, the facility ceased intake of clients as of December 27, 2024. LPA Marquez stated that Community Care Licensing (CCL) had not been given a written notice that the facility was pausing its operations. A written statement from the LIcensee is required to state the date the "pause in intake" occurred, and give the expected date of resuming intake of youth to be served at this facility. The physical plant inspection started with the "UR Building" where youth can have space for downtime and a break. Currently the back yard is not available due to painting renovations at the "Main Building." The UR building has a bottom floor where the youth bathroom is located. The bathroom hot water temperature was measured at 105.8 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible in areas where clients will not have access. Cleansers/chemicals are locked and stored in a locked cabinet in one of the locked staff offices. The First Aid Kit is located on the second floor and contained all required supplies; the tweezers are located in the locked staff office downstairs. The building had one smoke/carbon monoxide detector in the hallway, and were checked and were operable. There are no guns or weapons in the facility as stated by Program Manager. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures and Personal Rights. The disaster plan and visitor policies were in storage at Main building due to the renovation painting. Emergency exits were free from obstruction in the UR building. Cont. on 809-C The backyard was not available to youth during the painting renovation. However LPA Marquez and Program Manager Garcia did a walk through of the yard space. LPA observed that there are no signs giving caution about the prominent eastern hillside on facility grounds, and neither are there hand rails. LPA and Program Manager inspected the "old tree house" and the abandoned chicken coop. Both small buildings are accessible by walking on a steep upward hill walkway made from both wooden beams on the ground and large rock tiles. The facility will be given a type B deficiency and asked to have a Plan of Correction submitted to LPA Marquez to resolve this issue, see LIC809-D for specific regulation and deficiency summary. The Main Building was inspected and LPA Marquez observed that all rooms were being repainted, and all cabinets were being repainted. The courtyard of the Main Building was not an accessible walkway due to being currently renovated. Its renovation will be completed in the near future and before clients are residing in the Main Building. All the staff files are stored and secured digitally. LPA reviewed 3 staff files. One staff, Program Manager Monica Garcia was interviewed. All the staff have met the training and qualification requirements per regulation requirements. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Based on the facility inspection, and files reviewed there was one deficiency, type B given for hazardous area accessible in the backyard of the facility. An exit interview was conducted with Program Manager Monica Garcia, and a copy of this report was explained and provided to her, and emailed to Crystal Goodwin, Regional Licensing and Compliance Manager of Newport Healthcare.

met_with: Monica Garcia, Progam Manager


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026, at 1: PM, Licensing Program Analyst (LPA) Stefanie Mutialu conducted an unannounced case management inspection of the facility. LPA Mutialu met with Executive Director, Amanda Seymour. LPA conducted a walkthrough of the facility, and no deficiencies were observed. On February 17, 2026, the Department received an Incident Report stating that on February 12, 2026, a Child (C1), please refer to Confidential Names List dated 03/11/2026, gained access to a kitchen knife and began running with the kitchen knife when staff (S1) went to grab a kiwi. For this reason, the Group Home (GH) is receiving a Type A citation for violation of Title California Code of Regulations, Division 6, Chapter 1, Article 06, Continuing Requirements, section 80078(a): Responsibility for Providing Care and Supervision (See LIC809-D). LPA conducted one (S1) staff interview and requested/reviewed client records. An exit interview was conducted and a copy of this report, and Confidential Names (LIC 811), and Appeal Rights were provided to Executive Director, Amanda Seymour. Due to technical difficulties a copy of this report was emailed to the facility at the time of inspection

met_with: Executive Director, Amanda Seymour


summary: Facility Evaluation

raw_content:
Narrative:
On July 21, 2022 at 1:48pm, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct a Required Two Year Annual inspection of the facility. The facility was inspected inside and out with Residential Supervisor Fausto Aramburo. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in one of the client bathrooms was measured at 118.2 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible to areas where clients will not have access. The medications were stored and locked in a cabinet in the medication room in the hallway. Cleansers/chemicals are locked and stored in a locked supply closet. Sharp knives are inaccessible and stored in a locked drawer in the kitchen. The First Aid Kit is located in the medication room and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallways were checked and were operable. There are no guns or weapons in the facility as stated by Residential Supervisor Fausto Aramburo. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. There is a swimming pool located in the backyard of the facility which is made inaccessible with a pool cover. Emergency exits were free from obstruction. Due to time constraints and the need to complete client/staff interviews, client/staff file reviews, this inspection will need to be continued at a later date. LPA discussed and reviewed the following inspection components; Operational Requirements, and Emergency Disaster Preparedness. Based on the facility inspection, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained to Residential Supervisor Fausto Aramburo. Due to printer malfunction, this report will be emailed to Residential Supervisor Fausto Aramburo.

visit_type: Annual

met_with: Fausto Aramburo


summary: Facility Evaluation

raw_content:
Narrative:
On August 17, 2022 at 10:46am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual Continuation of the Required Two Year Annual inspection that began on 07/21/2022. LPA met with Program Manager Ellen Asquith. During the inspection, LPA reviewed client and staff files. A sample of six client files were reviewed during the inspection. All client files had the required documents per Title Regulations. All client files are maintained on a secured internet database. All the staff files are stored and secured at a different facility location (#306090011). Staff records are also accessible electronically via a secured records portal. LPA reviewed 10 staff files. All the staff have met the training and qualification requirements per regulation requirements. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. One facility staff was interviewed. Based on the facility inspection, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained to Program Manager Ellen Asquith. Due to printer malfunction, this report will be emailed to Program Manager Ellen Asquith.

met_with: Ellen Asquith


summary: Facility Evaluation

raw_content:
Narrative:
On August 19, 2022 at 12:26pm, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual Continuation of the Required Two Year Annual inspection that began on 07/21/2022. LPA met with Director Amanda Seymour. During the inspection, LPA conducted client and staff interviews. LPA discussed and reviewed the following inspection components; Emergency Intervention Plan. During the inspection, LPA conducted interviews with three facility staff and four children. Two children declined to be interviewed. Based on the facility inspection, interviews, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained to Director Amanda Seymour. Due to printer malfunction, this report will be emailed to Director Amanda Seymour.

met_with: Amanda Seymour


summary: Facility Evaluation

raw_content:
Narrative:
On May 29, 2024 at 10: AM, Licensing Program Analyst (LPA), Jacqueline Garcia arrived unannounced at the facility to conduct an Annual inspection of the facility. The facility was inspected inside and out with Amanda Seymour. LPA discussed and reviewed the following inspection components, Physical Plant, Operational Requirements, Disaster Preparedness, Emergency Intervention Plan, and client and staff files. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water measured at 113 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible to areas where clients will not have access. The medications were stored and locked in a cabinet in the medication room in the hallway. Cleansers/chemicals are locked and stored in a locked supply closet. Sharp knives are inaccessible and stored in a locked drawer in the staff office. The First Aid Kit is located in the medication room and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallways were checked and were operable. There are no guns or weapons in the facility as stated by Amanda Seymour. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. There is a swimming pool located in the backyard of the facility which is made inaccessible by gated fence. Emergency exits were free from obstruction. **. LPA reviewed client and staff files a sample of six client files were reviewed during the inspection. All client files had the required documents per Title Regulations. All client files are maintained on a secured internet database. LPA interviewed one client and second client declined to be interviewed. All the staff files are stored and secured at a different facility location (#306004815). Staff records are also accessible electronically via a secured records portal. LPA reviewed five staff files. All the staff have met the training and qualification requirements per regulation requirements. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Two facility staff were interviewed. Based on the facility inspection, interviews, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained and given to Amanda Seymour.


summary: Facility Evaluation

raw_content:
Narrative:
On March 6, 2026 at 9: AM, Licensing Program Analyst (LPA) Gilbert Marquez arrived unannounced at the facility to conduct an annual inspection of the facility. The facility was inspected inside and out with Whitney Rodgers, Compliance Specialist. Facility is licensed to serve six ambulatory clients, age groups 7-12 or 12-17 years of age. The facility is current with their licensing fees. The census was zero clients at the time of the inspection. LPA discussed and reviewed the following inspection components, Physical Plant, Operational Requirements, Disaster Preparedness, Emergency Intervention Plan, and client and staff files. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. All the required linens were on every bed. The two bathrooms and three bedrooms are arranged the following way: Bedroom #1 will sleep two clients, and has two twin beds, drawer space, walk-in closet and one large desk Bedroom #2 will sleep two clients and has two twin beds, drawer space, closet and one large desk Bedroom #3 will sleep two clients and has two full beds, drawer space, walk-in closet, and two desks Bathroom #1 is next to bedroom #1, and has a toilet, sink, shower, and a nonfunctional hot tub and is used by clients Bathroom #2 is next attached bedroom #3, has a jack and jill sink, shower, toilet and is used by clients The hot water measured in bathroom #1 and bathroom #2 was at 119.5 degrees Fahrenheit, which is in the regulatory range of 105 degrees to 120 degrees Fahrenheit. All hazardous items have been properly made inaccessible to clients. The medications are going to be stored and locked in a cabinet in the locked medication room in the hallway. **Continued on LIC809C** **Continued from LIC809** Cleansers and chemicals are locked and stored in a locked supply closet. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The First Aid Kit is located in the medication room and contained all required supplies. There are no guns or weapons in the facility as stated by Whitney Rodgers. The facility's smoke and carbon monoxide detectors in the hallways were checked and were operable. The facility has several fire extinguishers on campus and were all maintained in February 2026. There was a sample menu posted in the kitchen. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, and Emergency Disaster Plan. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a swimming pool located in the backyard of the facility which is made inaccessible by gated fence, and no less than five feet high, with a latch that is no more than six inches from the top of the gate. There are three additional buildings on this facility campus. The MMA Studio was toured by LPA, and no health and safety hazards were found. There is a therapy cottage that has therapy offices for use by the staff and clients. LPA toured the therapy cottage and no health and safety hazards were found. There is a classroom building where clients would attend their online courses, and there are staff offices. LPA toured the classroom building and no health and safety hazards were found. LPA interviewed one staff, and there are no clients in care. Based on the facility inspection, interview, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained and given to Whitney Rodgers, Compliance Specialist.

met_with: Whitney Rodgers, Compliance Specialist


facility_name: NEWPORT ACADEMY- ARENA

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 9/27/22 at 12: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Newport Academy- Arena and spoke with Rajay Peralta, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. This complaint was taken as an assignment by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Eddie Phung on 07/28/2022. During investigation, confidential interviews, police reports, and physical evidence were obtained, it was determined that a staff sexually abused client in care. Therefore, the preponderance of evidence standard has been met, therefore the above allegation, Staff sexually abused client in care is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 84072(d)(11) Personal Rights. Please refer to attached 9099D. An exit interview was conducted, and a copy of this report was given to RayJay Peralta, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: NEWPORT ACADEMY- ARENAFACILITY NUMBER: 015650125

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

report_type: Complaint Investigation

met_with: RayJay Peralta

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13At 10am, Liensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced complaint investigation inepsection. LPA met with Residential Supervisor Gordo Mahal, who helped facilitate this inspection. Currently in care are 6 ambulatory clients. On 02/09/2023, the San Jose Children's Resdiential Program Regional Office received a complaint for Newport Academy Arena with three allegations: (1) Facility is providing care and supervision to youths that do not reside at the home; (2) Facility is catering food to other facilities and not appropriately handled; and (3) Facility is not following plan of operation with laundry. This complaint was investigated by LPA Madi Fremont and Licensing Program Manager (LPM) Helga Wong. Over the course of this investigation, LPA Fremont and LPM Wong interviewed 4 staff and 1 client at the facility. Based on these interviews, it was found that the facility provides schooling for another group home, Newport Academy Oasis, 5 days per week from 8am-12pm. When clients from Oasis come to Arena for schooling, they are accompanied by residential counselors and clinical staff to make sure staff/client ratios are maintained. It was also found that Newport Arena provides meals to the Oasis facility, which are delivered by facility van each day. Newport Arena only provides laundry services for clients in care are Arena, and no laundry is sent out for cleaning. This agency has investigated the allegations (1) Facility is providing care and supervision to youths that do not reside at the home; (2) Facility is catering food to other facilities and not appropriately handled; and (3) Facility is not following plan of operation with laundry, and has found that although the allegations may be true or are valid, the preponderance of evidence standard has not been met, therefore the allegations are unsubstantiated based on review of facility records and interviews with staff and client that show the facility is following its operating standards. At this time, no deficiencies were observed or cited. An exit interview was conducted and a copy of this report was emailed to Residential Supervisor Gordo Mahal, whose signature on this form confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Residential Supervisor Gordo Mahal

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13A complaint investigation was conducted today by LPA Madi Fremont and LPM Helga Wong to investigate the above allegation. LPA and LPM met with Regional Executive Director Pamela Alba and Vice President Rebecca Whitehead at the facility. LPA Fremont and LPM Wong conducted multiple interviews with witnesses and facility did not have more than 6 clients in placement. Client Census Records were reviewed, facility had between 5 to 6 clients for this facility between April and May of 2023. Based on records and interviews, there was no information that support the allegation that the facility is over capacity where there are more that 6 clients. Several months ago there were some clients from another facility visited this facility for several hours in the morning for school but stopped several weeks ago and now they stay at their facility for school. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that this facility is over capacity. Therefore, the above allegations are unsubstantiated. Exit interview was conducted with ED Pamela Alba and VP Rebecca Whitehead. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nelson Martinez LICENSING EVALUATOR NAME: Helga Wong LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Pamela Alba and Rebecca Whitehead


raw_content:
Narrative:
Based on review of the program statement, the program statement says, "Residents have the right to have visitors during waking hours without prior notice however, to ensure the consistency of the daily schedule, we recommend visitation be scheduled with the resident's Treatment Team at least 48 hours prior to the day of the visit." Based on confidential interview and record review, the allegation that client was not allowed to have visitors in the facility has met the preponderance of the doubt and is therefore substantiated. This poses a threat to the health, safety, and/or personal rights to minors in care LPA delivered a Type B citation for Title California Code of Regulations 84072(d)(5) (see LIC809D). LPA conducted an exit interview and delivered appeal rights to Priscilla Hernandez, Program Director at 12:02PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 8/2/2023 at 11:50AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed agency. The purpose of this visit was to deliver the finding for the above allegation. LPA met with Priscilla Hernandez, Program Director. During the course of the investigation, LPA conducted nine interviews. LPA reviewed the intake agreement, the facility program statement, C1's treatment plan, and email correspondence. Based on confidential interview, one client alleges that on one occasion they were not informed when their authorized representatives were requesting visitation. Of the nine interviews, six interviewed stated that the facility protocol was to only allow visitation after the family therapy sessions. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: NEWPORT ACADEMY- ARENAFACILITY NUMBER: 015650125

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Priscilla Hernandez


raw_content:
Narrative:
LPA Hood reviewed the intake agreement, the facility program statement, Child Protective Service (CPS) Suspected Child Abuse Report (SCAR), C1's treatment plan, pertinent incident report, and email correspondence. Based on the incident report, CPS SCAR, and confidential interviews one client in care was touched inappropriately by another client during their time in care. Based on record review and confidential interview, there was discrepancy about whether the incident occurred in February 2023 or March 2023. The allegation that client was inappropriate with another client has met the preponderance of doubt, and therefore the allegation is substantiated. This poses a risk to the health, safety, and/or personal rights to the youth in care. LPA delivered a Type B citation for Title California Code of Regulations 84072(d)(10) (see LIC809D). LPA conducted an exit interview and delivered appeal rights to Priscilla Hernandez, Program Director at 12:05PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 8/2/2023 at 11:45AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed agency. The purpose of this visit was to deliver the finding for the above allegation. LPA met with Priscilla Hernandez, Program Director. LPA Madeleine Fremont initially informed the facility of the allegation on 3/24/2023. LPA Fremont conducted nine interviews. Based on the nine interviews, four of those interviewed were aware of one client inappropriately touching another client in care. LPA Hood conducted eight interviews, two of which were follow-up interviews. Based on these interviews, four interviewed were aware of one client inappropriately touching another client in care. One of these interviews was a primary source to the allegation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: NEWPORT ACADEMY- ARENAFACILITY NUMBER: VISIT DATE: 08/02/2023

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


summary: Complaint Investigation - Unsubstantiated - 3 deficiencies - 1 allegation

raw_content:
Narrative:
Confidential client information shared with unauthorized persons. Based on record review of email correspondence, a facility staff member had shared a document containing a client's confidential diagnosis with an external party that was not approved to receive this knowledge. This poses an immediate threat to the health, safety, and/or personal rights of the client in care. LPA delivered a Type A citation for California Code of Regulations Title 22 80070(c) (see LI9099D). Lack of care and Supervision: not enough staff to meet the needs of the clients. Based on three confidential interviews, there were times in the facility during the day when the staffing was down to one person in the home. According to the program statement, the facility should have two staff on duty during shifts aside from overnight shifts. This poses a potential risk to the health, safety, and/or personal rights to clients in care, LPA delivered a Type B citation for California Code of Regulations Title 22 80022(k) (see LIC9099D). Facility did not report incidents in a timely manner. Based on four confidential interviews, C1 had committed self harm multiple times and received medical treatment for this self-harm. According to these interviews and record review, the facility had reported one of these incidents but according to the interviews there were multiple. The facility had not submitted an incident report regarding a previously substantiated inappropriate incident between two clients in the facility in a timely manner. The incident report was submitted on 3/10/2023; however, the incident accounted an incident that had occurred in mid-February 2023 and included follow-up on 3/3/2023. The incident report that was sent was erroneous and stated that the incident occurred outside the facility, which is incorrect according to record review of the CPS report and four confidential interviews. This poses a potential risk to the health, safety, and/or personal rights of the clients in care. LPA delivered a Type B citation for California Code of Regulations Title 22 80061(b) (see LIC9099D). Facility did not respond to authorized representatives in a timely manner. Based on three confidential interviews, record review of email correspondence, and review of the incident reports the facility had not reported self-harm that received medical treatment from facility nurse to the authorized representatives. According to confidential interview and record review, an incident had occurred regarding two clients on 2/10/2023 which was not communicated to the authorized representatives until 2/13/2023. This poses a potential risk to the health, safety, and/or personal rights of the clients in care. LPA delivered a Type B citation for California Code of Regulations Title 22 80061(A)(f) (see LIC9099D). Authorized representatives were not offered the chance to participate in the development of a client's needs and services plan. Based on two confidential interviews and email statement from the facility staff, there was no evidence that authorized representatives were offered the chance to participate in the development of a client's treatment plan. According to the facility protocol, the treatment plan should be signed by the authorized representative, based on email from facility staff this protocol had not been followed during C1's intake process. This poses a potential risk to the health, safety and/or personal rights of the clients in care. LPA delivered a Type B citation for California Code of Regulations Title Chapter 5 84068.2(d)(1) (see LIC9099D). Medication was not given as ordered by a physician. Based on record review of the Medication Administration Log and one confidential interview, C1's medication was not supplied on the evening of 3/13/2023. There was no explanation provided for the missing medication and according to confidential interview the prescribing doctor was not informed of the missed medication. This poses a potential risk to the health, safety, and/or personal rights of the clients in care. LPA delivered a Type B citation for California Code of Regulations Title Chapter 5 84070(b)(13) (see LIC9099D). LPA provided the facility the appeal rights and discussed the plan of correction for each violation. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor, whose signature confirms the receipt of this document. Psychotropic medication administered without prior parental authorization. According to interview with the reporting party, this allegation was not a concern. Based on three confidential interviews, the facility had received approval for the psychotropic medications administered and for a dosage change during C1's stay. Facility did not offer authorized representatives the opportunity to participate in a client's discharge planning. According to four confidential interviews, the facility staff's protocol would be to create a discharge plan as a clinical team and communicate this to the youth and authorized representatives. Per the confidential interviews, the team would not change their formal discharge summary based on authorized representatives' input, but they would accommodate the discharge planning that worked for the individual provided the authorized representatives thoughts. The facility had provided a discharge plan on C1's discharge plan that was not consistent with the authorized representative's collaboration. Based on record review of emails between authorized representatives and the facility staff, the facility staff had assisted C1 in seeking other options for discharge that were consistent with the authorized representatives' preferences. PRN medications not administered to a client when needed. Based on record review of the medication logs, there were not PRN medications prescribed that were not administered when necessary. According to two confidential interviews, there were PRN medications that might have been necessary at times, but there was not a prescription for the medications during C1's stay. Based on confidential interviews and record review, the following allegations may or may not have happened: - Psychotropic medication administered without prior parental authorization. - Facility did not offer authorized representatives the opportunity to participate in client's discharge planning. - PRN medications not administered to a client when needed. These three allegations have not met the preponderance of doubt and are therefore unsubstantiated. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor at 1:50PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 8/21/2023 at 12:55PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the above allegations. LPA met with Kimberly Porter, Family Therapist. Rayjay Peralta, Residential Supervisor, arrived to go over the findings at 1:20PM. During the course of the investigation, LPA Madi Fremont, LPA Selena Hood, and Licensing Program Manager (LPM) Helga Wong had conducted sixteen interviews with fourteen participants from 5/16/2023 to 7/26/2023. LPA Fremont initially informed the facility of the allegations on 5/16/2023. LPA Hood and LPM Wong reviewed medication records, C1's treatment plan, emails with facility staff, C1's daily notes, facility program plan, and CPS report. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: NEWPORT ACADEMY- ARENAFACILITY NUMBER: VISIT DATE: 08/21/2023

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

Deficiencies:
80070(c): Based on record review, a confidential diagnosis was shared with an external party.1
2
3
4
5
6
7
80022(k): Based on confidential interview and record review, there were times that
1
2
3
4
5
6
7Another facility has currently stopped placement, and those staff have been reallocated to the remaining homes.
80061(b): 1
2
3
4
5
6
7

met_with: Rayjay Peralta

title: Child Records - All information and records obtained from or regarding clients shall be confidential. This requirement is not met as evidenced by

title: Plan of Operation - The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. This requirement is not met as evidenced by

title: Reporting Requirements - (b) ... report shall be made to the licensing agency within the agency's next working day... a written report.. shall be submitted to the licensing agency within seven days following the occurrence of such event. This requirement is not met as evidenced by

description:
1
2
3
4
5
6
7


raw_content:
Narrative:
Based on the confidential interview and record review, the allegation that staff administered mediation to minor in care without proper authorization has met the preponderance of doubt and is therefore substantiated. This poses an immediate risk to the health, safety, and/or personal rights of clients in care. LPA delivered a Type A citation for Title California Code of Regulations 84070(b)(12)(A) Children's Records. On 4/30/2024, LPA conducted an exit interview and delivered appeal rights to Fausto Aramburo, Residential Supervisor, at 3:26pm whose signature confirms the receipt of this document. *This report was initially delivered on 4/15/2024, LPA re-delivered to the facility on 4/30/2024 to deliver as a Type A citation.*

Investigation Findings:
13On 4/15/2024 at 1:50pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the above listed allegation. LPA met with Satwinder Mahabir, Clinical Director. During the course of the investigation, LPA conducted eight interview from 4/4/2024 to 4/8/2024. LPA reviewed the medication logs, daily notes, and treatment plan for one client in care. Based on confidential interviews and record review, the precribing doctor and authorized representatives had an agreement that medication authorization was contigent on approval from both authorized representatives. The facility did not receive written parental authorization prior to administering medication to one client on two days. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO ASC, TRAEGER AVE., SUITE FACILITY NAME: NEWPORT ACADEMY- ARENAFACILITY NUMBER: 015650125

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Satwinder Mahabir


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on record review, LPA found that facility staff were not receiving training on sexual development. The preponderance of evidence standard has been met, and the above allegation is substantiated. The facility is also required to hold trainings on client sexual development as per the Non-Compliance Conference on 12/07/2023. One Type B violation will be issued under California Code of Regulations 84065(i)(3) Personnel Requirements. An exit interview was conducted, appeal rights discussed, and a copy of this report was given to Elizabeth Jimenez, Residential Supervisor.

Investigation Findings:
13On September 11th, 2025 at 11:00AM, Licensing Program Analyst (LPA) Hanako Primer made an unannounced complaint inspection at the above licensed facility. LPA met Elizabeth Jimenez, Residential Supervisor, and MIsty England, Administrator and explained the purpose of the visit. Present during the inspection were six clients. LPA inspected five random staff training records and facility physical plant. Two out of five records did not contain trainings on sexual development. LPA did not observe trainings on sexual development (encompassing 84065(i)(3)(V), 84065(i)(3)(X), 84065(i)(3)(Y), 84065(i)(3)(Z)) in three out of four staff files at a previous annual inspection conducted on 08/25/2025. Though a one-time training was held on this topic, the training was not incorporated into on-boarding training for direct care staff. Following a technical violation issued on 08/25/2025, the facility incorporated sexual development training into on-boarding. LPA observed training plan for new hires with sexual development training included. LPA inspected one new staff member's training record, which included sexual development training. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Hanako Primer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: NEWPORT ACADEMY- ARENAFACILITY NUMBER: VISIT DATE: 09/11/2025

met_with: Elizabeth Jimenez - Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) David Hiett conducted a Pre-licensing inspection for a Group Home license and met with the Administrator Holvis Delgadillo. The entire home was toured, inside and out. The application is to provide residential drug and alcohol and mental health treatment for six adolescents with private and insured placement, for boys and girls ages 12 - 17 years. The home is single story with smoke/carbon monoxide detectors and fire extinguishers distributed appropriately. Illuminated exit signs are located throughout the facility. All required postings are present in the entry hall of the main entrance. Three rooms are designated as bedrooms each with a bathroom and two beds. Three rooms are dedicated offices and there are two group therapy rooms. There is a dining room opposite the kitchen. The garage is anticipated to be used as a gym and another room to be used as a classroom. There is a laundry room where toxics are stored in locked cabinets. A permanent backup generator is located next to the house. There is a separate unit behind the main house reserved for staff usage and consists of a kitchen, bathroom and offices. To the left of the main house is an equestrian area with a locking front gate. There is a horse barn that will not be host to any animals. Horses for equestrian therapy are boarded locally and are brought to the facility as needed. All stables have locking gates. There is an upstairs hay loft that will be inaccessible to clients. Per the fire inspection, the loft may not be used as a domicile. {Continued on LIC809-C} There is a medication room with a locked door and locked storage of medications. Food is prepared offsite and brought to the facility for all meals. Sharps are stored in a locked cabinet in the kichent. There are pantry areas sufficient to hold an adequate amount of dry food storage several commercial refrigeration units are present with ample capacity. The facility is aware the water is tot be maintained within the regulated range 105-120F. There are no open bodies of water and no firearms are located on site. A copy of this report has been shared with the facility.

met_with: Holvis Delgadillo


summary: Facility Evaluation

raw_content:
Narrative:
On 03/21/2023 at 3PM, Licensing Program Analyst (LPA) Madi Fremont, Licensing Program Manager (LPM) Helga Wong, and Regional Manager (RM) Nelson Martinez met virtually with the following representatives from Newport Academy Happy Valley: Regional Executive Director Pamela Alba, Licensing and Compliance Manager Crystal Goodwin, and Program Director Priscilla Hernandez. Both parties met to discuss recent neighborhood complaints at the Arena location at Johnston Rd., Pleasanton, CA. During this meeting, representatives of Arena explained the ongoing issues with the facility's neighbor, who shares an easement on the driveway with the facility. There is a coded gate at the entrance to the driveway, and the neighbor has been consistently complaining about the volume of cars that go in and out of the gate to the facility each day and through the night. Both parties discussed solutions for this issue, and it was decided that all neighborhood complaints would be forwarded to LPA Fremont going forward to keep an eye on the situation. Newport Academy also discussed attempts they had made at rectifying this situation, including but not limited to building a fence for the neighbor to maintain privacy and buying the neighbor's house at a high cost to allow the neighbor to move to another area. Both parties will be keeping an eye on the situation and updating the other periodically until a solution is decided. An exit interview was conducted and a copy of this report was emailed to Newport Academy representatives. Due to this meeting being conducted virtually, no facility representative signature was recorded.

met_with: Pamela Alba, Crystal Goodwin, Priscilla Hernandez


summary: Facility Evaluation

raw_content:
Narrative:
On 8/28/2023 at 11:05AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required annual inspection. LPA met with Rayjay Peralta, Residential Supervisor. LPA conducted a site inspection of the facility. There are currently six clients present in the facility, the six clients share rooms in sets of two. LPA observed the house to be clean, tidy, and in good repair. LPA observed there to be a sufficient amount of fresh and non-perishable foods. LPA also observed the posted license and children's rights. LPA observed that medication, dangerous objects, and cleaning supplies are all kept locked. LPA reviewed the healthy and safety binder, six client files, centrally stored medication binder, medication count documentation, client medical charts, emergency contact binders for the clients, and medication orders. LPA conducted one confidential interview (see LIC812). Further record review is necessary in order to finish the annual inspection, LPA will return to finish conducting the inspection. LPA met with Rayjay Peralta, Residential Supervisor, at 2:36PM whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/29/2023 at 10:35AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required annual inspection. LPA met with Rayjay Peralta, Residential Supervisor. Priscilla Hernandez, Program Director, arrived at the facility at 11:50AM to assist with the inspection. LPA conducted a review of six residents files, including treatment plans and medication orders. LPA conducted four confidential interviews (see LIC812s). Based on record review, LPA delivered Technical Assistance for California Code of Regulations Title 22 80071(a)(1) (see LIC9102). LPA also delivered a Technical Violation for California Code of Regulation Title 22 84087(e) and Health and Safety Code 1565(a)(6) (see LIC9102s). Based on record review, there was not a verification of authorized representative's approval of treatment plans (Needs and Service Plans) for six of six clients. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPA delivered a Type B citation for California Code of Regulations Title 22 84070(c)(1) (see LIC809D). Further inspection is necessary in order to finish the required annual inspection. LPA will return to the facility. LPA conducted an exit interview with Priscilla Hernandez, Program Director at 2:40PM whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/6/2023 at 12:50PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit it to continue the required annual inspection. LPA met with Rayjay Peralta, Residential Supervisor. LPA had made previous visits to conduct the annual inspection on 8/28/2023 and 8/29/2023. During this inspection, LPA followed up on previously requested files. On 8/29/2023, LPA had verbally requested to view the six clients' medical screening, diagnoses from a medical professional, health records, and their immunization records.On 9/6/2023, LPA had requested the records from Program Director, Priscilla Hernandez and Compliance Officer, Crystal Goodwin via email at 1:33PM on 9/6/2023. LPA received the documentation from Compliance Officer, Crystal Goodin and reviewed these records. Based on the records reviewed, two of the youth had not had immunization records available to the facility. LPA delivered a Type B citation for Community Care Licensing Title 22 84070(c)(3) (see LIC809D). LPA also requested staff files from Rayjay Peralta, Residential Supervisor, at 1:10PM. LPA received a call from Priscilla Hernandez, Program Director at 2:53PM explaining that they were having issues sending the staff files to LPA because the files were in a zip file. Program Director sent the files at 3:29PM, LPA observed that the following files were present for staff members: clearance, training records, drug screening, CPR certificate, job description, resumes, mandatory reporting acknowledgment, driver's licenses, and health screenings. LPA will return to review the staff files and finish conducting the annual inspection. LPA conducted an exit interview with Rayjay Peralta, Residential Supervisor at 3:42PM and provided appeal rights.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/15/2023 at 10:00AM, Licensing Program Analyst (LPA) Selena Hood and Licensing Program Manager (LPM) Helga Wong conducted a Microsoft Teams Meeting with Crystal Goodwin, Compliance Officer and Annie Gendaszek, Associate Vice President of Compliance and Licensing. During the meeting, attendees discussed the prudent parenting standards noted in the compliance plan. Attendees discussed that instead of prudent parent standards training, the facility will provide information about the training that staff have and will receive on individualized care for youth, common sense supervision, emotional development, sexuality development, and health development. The meeting discussed the psychotropic medications administration log (PMAR). Compliance Officer discussed that the facility has a medication log in their system that meets the criteria. LPM asked for a sample of this in the system. Vice President of Compliance and Licensing discussed the current plans that their upper management team has done so far to work on compliance plan. Facility requested that the compliance plan due date of 1/5/2024 be extended to 1/30/2024, LPM Wong approved 1/30/2024 as the new due date. LPA Hood conducted an exit interview with Crystal Goodwin, Compliance Officer and Annie Gendaszek, Associate Vice President of Compliance and Licensing at 10:47AM. This document is sent for virtual signature.

met_with: Crystal Goodwin


summary: Facility Evaluation

raw_content:
Narrative:
On 3/26/2024 at 1:00pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct a case management visit following the Non-Compliance Conference conducted on 12/7/2023. LPA met with Fausto Aramburo, Administrator, at 1:40pm. LPA requested the staff schedule, the facility board minutes, and the client files. LPA received the board minutes that were pertinent to this facility during a prior visit on 3/21/2024. LPA reviewed the March staff schedule and saw that the Administrator was included on the staff schedule and worked Tuesday through Saturday. LPA reviewed the treatment plans, admission agreements, and grievance procedure acknowledgments for three clients. LPA found that the three clients had these plans in their digital files including client and authorized representative signatures. One client did not have a signature on their treatment plan. Administrator showed LPA correspondence with the clinical team and authorized representative requesting signature. LPA conducted three confidential interviews. LPA conducted a walk through of the facility. LPA did not observe physical plant deficiencies. No deficiencies were cited during this visit. LPA conducted an exit interview with Fausto Aramburo, Administrator, at 3:12pm whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/28/2025 at 11: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection to the licensed facility. The purpose of this inspection was to conduct the quarterly inspection for the Non-Compliance Conference initially had on 12/7/2023. LPA met with Tiffany St. Jean, Residential Supervisor and Elizabeth Jimenez, Residential Supervisor. LPA was informed there are six clients at the facility. LPA reviewed LIC 500 and staff weekly schedule, which was in compliance. In addition, LPA inspected nightly check-in schedule. LPA found nightly checks to be random. LPA reviewed quarterly board of directors meeting minutes. LPA inspected six client files, including treatment plan, admission agreement, medication log, and bio-psychosocial exam. LPA conducted five confidential interviews. At this time, one client denied to be interviewed. LPA inspected the physical plant of the facility. No physical plant deficiencies were found at the visit. At this time, the inspection is not complete and it will be concluded at a later date. No deficiencies were cited at this inspection. LPA requested for shift reports and incident reports to be sent via email for further inspection. An exit interview was conducted with Tiffany St. Jean, Residential Supervisor and Elizabeth Jimenez, Residential Supervisor. A copy of the report was printed and left with Tiffany St. Jean, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/28/25 at 11: AM, Licensing Program Analyst (LPA) Mona Lam made an unannounced case management inspection at the above listed facility. LPA Lam met with Tiffany St. Jean, Residential Supervisor and Elizabeth Jimenez, Residential Supervisor. LPA Lam conducted a walk through of the facility. The purpose of the inspection was to conduct a client interview for a complaint. LPA Lam attempted a client interview. A client denied an interview at this time. An exit interview was conducted with Tiffany St. Jean, Residential Supervisor and Elizabeth Jimenez, Residential Supervisor. A copy of the report was printed and left with Tiffany St. Jean, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/03/25 at 10: AM, Licensing Program Analysts (LPAs) Mona Lam and Kristin Pierotti made an unannounced case management inspection at the above listed facility. LPA Lam met with Alvaro Zambrano. The purpose of the inspection was to conduct a client interview for a complaint. LPA Lam and LPA Pierotti conducted one client interview. An exit interview was conducted with Alvaro Zambrano. A copy of the report was printed and left with Alvaro Zambrano, whose signature on this form confirms receipt.

met_with: Alvaro Zambrano


summary: Facility Evaluation

raw_content:
Narrative:
On 02/25/25 at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection to the licensed facility listed above. The purpose of the inspection is to amend the report on the non-compliance conference (NCC) inspection on 02/03/25. LPA met with Elizabeth Jimenez, Residential Supervisor. LPA conducted an exit interview with Elizabeth Jimenez, Residential Supervisor and a copy of the report was provided prior to leaving the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/17/25 at 10: AM, Licensing Program Analysts (LPAs) Mona Lam and Hanako Primer conducted an unannounced inspection to the licensed facility listed above. The purpose of the inspection is to continue a quarterly non-compliance conference (NCC) inspection. LPAs met with Alvaro Zambrano, Program Manager, Emily Mares, Residential Supervisor, and Fausto Aramburo, Compliance Specialist. At the time of the inspection, there were three clients in the facility. LPAs inspected facility nightly check-in schedule and staff training record. LPAs conducted a physical plant check of the facility. Facility did not maintain documentation of administrator training on administrator duties and responsibilities. LPAs reviewed client medication administration records. Facility did not conduct monthly review/audit on medication and medication record. According to client interview and review of staff schedule, LPAs found that staff was not in ratio multiple times. A technical violation was issued to the licensee under 80022(k) Plan of Operation. Program Manager Alvaro Zambrano informed LPAs that there was an administrator change, and Janelle Bush was no longer the administrator for the above licensed facility. The change had occurred in February 14th 2025. A technical violation was issued to the licensee under 84061(e) Reporting Requirements. LPAs conducted an exit interview with Alvaro Zambrano, Emily Mares, and Fausto Aramburo and delivered two (2) technical violations. A copy of the report was discussed and provided to Emily Mares prior to leaving the facility.

met_with: Alvaro Zambrano - Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 5-9-25 10AM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Newport Academy-Arena and met with Kimberly Abraham, Counselor, who helped with the inspection. The facility is clean and in good repair. The purpose of the inspection was to conduct interviews and obtain documents. An exit interview was conducted and a copy of this report was given to Kimberly Abraham, Counselor.

met_with: Kimberly Abraham, Counselor


summary: Facility Evaluation

raw_content:
Narrative:
On July 8th at 2:10PM, Licensing Program Analyst (LPA) Hanako Primer and Licensing Program Manager (LPM) Joel Segura conducted an unannounced inspection to the above licensed facility. The purpose of the inspection is to continue a quarterly non-compliance conference (NCC) inspection. LPAs met with Misty England, Administrator. At the time of the inspection, there were four clients in the facility. LPA observed trainings on individualized care for youth, common sense supervision, emotional development, sexuality development, health development, personal rights, reporting requirements, house rules, and incident reporting in one staff file. LPA and LPM conducted a physical plant inspection of the facility, and observed two bedrooms, three bathrooms, kitchen, living room, and backyard. At 3:00PM LPA observed an unlocked padlock on the back yard fence door. The door led to a ravine and propane tank. LPA verified the lock was closed at 3:17PM. LPA reviewed four client needs and services plan and observed bio-psycho-social exams. The non-compliance conference inspection is not complete at this time. LPA will return at a later time to complete the inspection. No deficiencies were cited at this time. An exit interview was conducted and a copy of this report was given to Misty England, Administrator.

met_with: Misty England - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 15th at 10:30AM, Licensing Program Analysts (LPAs) Hanako Primer and Lisette Valenzuela conducted an unannounced inspection to the above licensed facility. The purpose of the inspection is to continue a quarterly non-compliance conference (NCC) inspection. LPAs met with Emily Mares, Residential Supervisor. At the time of the inspection, there were six clients at the facility. LPA inspected four staff (4) training records. LPA observed trainings on individualized care for youth, common sense supervision, emotional development, sexuality development, health development, personal rights, personnel requirements, reporting requirements, house rules, and medication administration. Two (2) out of five (5) training records inspected did not contain trainings on emotional development, sexuality development, and health development. Residential Supervisor stated S3 and S5 would complete the trainings on 07/15/2025. LPA reviewed facility nightly check-in schedule and observed checks within the fifteen-minute intervals. On four (4) occasions, staff member conducted checks with more than fifteen minutes between them. LPAs cited one Technical Violation under CCR 80078(a) Responsibility for Providing Care and Supervision. LPA conducted three confidential client interviews. LPA inspected LIC500 and verified administrator was working twenty hours a week. LPAs inspected staff schedule for June and July 2025. Staff were in ratio. LPAs inspected three client Needs and Services Plans and observed monthly reviews. Two clients had been at the facility for less than one month. Facility did not conduct monthly review/audit on medication and medication record. Compliance Specialist, Fausto Aramburo, stated that medication record audit/review is currently in the process of being developed. No deficiencies were cited at this time. An exit interview was conducted, and a copy of this report was given to Emily Mares, Residential Supervisor.

met_with: Emily Mares - Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On August 20th at 10:10AM, Licensing Program Analyst (LPA) Hanako Primer conducted an unannounced Annual Inspection at listed facility. LPA met with Misty England, Administrator and Elizabeth Jimenez, Residential Supervisor, and toured the facility inside and out. The Group Home is licensed to serve six clients. Present during the inspection were four clients. LPA reviewed four client records, disaster preparedness plan, restraint log, past licensing reports, and board of directors minutes. LPA Primer toured the facility. LPA observed three bedrooms and four bathrooms. LPA observed facility license, personal rights, fire clearance, meal menu, grievance procedures, and other forms posted on the walls throughout the facility. LPA tested the water temperature and found it to be 114 degrees which is in range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the nursing room. The facility is in good repair and clean. LPA toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. LPA interviewed two staff. LPA observed facility was conducting only fire drills. LPA issued one Technical Assistance under Health and Safety Code 1565(c) Other Provisions. See LIC 9102. Based on review of medication administration records, LPA observed psychotropic medications being documented on the same record as non-psychotropic medications. LPA issued one Technical Violation under California Code of Regulations 84070(b)(16) Children's Records. See LIC 9102. Based on review of client records, two out of four client records did not contain immunization records. LPA issued one Type B deficiency under California Code of Regulations (CCR) 84070(b)(7) Children's Records See attached 809-D form. An exit interview was conducted, appeal rights discussed, and a copy of this report was given to Misty England, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On August 25th at 10:24AM, Licensing Program Analyst (LPA) Hanako Primer conducted an unannounced Annual Inspection continuation at the listed facility. LPA met Elizabeth Jimenez, Residential Supervisor, and explained the purpose of the visit. The Group Home is licensed to serve six clients. Present during the inspection were four clients. LPA reviewed five staff files including personnel records, training records, health screening reports, emergency intervention training, and CPR/first aid certificates. LPA did not observe trainings on sexual development (encompassing 84065(i)(3)(V), 84065(1)(3)(X), 84065(1)(3)(Y), 84065(1)(3)(Z)) in three out of four staff files. LPA observed facility had assigned said trainings to the staff members, but the training had not been completed within the 90 day time frame from hire. Compliance Specialist stated that the facility will work with the education department to ensure the training is incorporated into the on-hire training. LPA issued one Technical Violation under CCR 84065(1)(3) Personnel Requirements. LPA interviewed one client. Three clients declined to interview. No deficiencies were issued at this time. An exit interview was conducted, appeal rights discussed, and a copy of this report was given to Elizabeth Jimenez, Residential Supervisor.


summary: Facility Evaluation

raw_content:
Narrative:
On November 20th, 2025 at 9:00AM, Licensing Program Analyst (LPA) Hanako Primer and Licensing Program Manager (LPM) Joel Segura conducted a Microsoft Teams Meeting with Crystal Butler, Compliance Manager, Misty England, Head of Operations, Mark Pellegrino, Chief Compliance Officer, Joe Vaccaro, Vice President of Residential Operations, and Kristina Schemnitzer, Executive Director . LPA and LPM notified facility management that the facility's case will be forwarded for legal review due to compliance issues in the prior two years of inspections. Multiple citations relating to the non-compliance plan terms were issued during the period of the non-compliance plan. During the meeting, attendees discussed ownership changes of Newport Academy's licensee, Monroe Operations LLC. LPA Primer conducted an exit interview with Crystal Butler, Compliance Manager. This document is sent for virtual signature.

met_with: Crystal Butler - Compliance Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 04/17/25 at 10: AM, Licensing Program Analysts (LPAs) Mona Lam and Hanako Primer conducted an unannounced inspection to the licensed facility listed above. The purpose of the visit is to continue a quarterly non-compliance conference (NCC) inspection. LPAs met with Alvaro Zambrano, Program Manager. At the time of the inspection, there were four clients at the facility. One client is out of the facility on a psychiatric hold. LPAs conducted four confidential client interviews. LPAs inspected staff schedule and LIC500. LPAs reviewed five client files. During the review of the client files, LPAs reviewed that five clients had not received a signature on their treatment plan from their parent or authorized representative. The facility reached out to authorized representatives via email but they did not respond. A technical violation was issued to the licensee under 84068.2(d)(1) Needs and Services Plan. LPAs inspected facility internal incident reports. LPAs observed an incident report not submitted to the Department from March 2025. Due to review of facility's internal incident reports, a deficiency was issued to the licensee for failure in sending written incident reports to the Department under 80061(b) Reporting Requirements. As a result of the facility's repeat violation within the last 12 months, the facility will be issued a civil penalty for $1000.00 on 04/17/25 (refer LIC 421IM). Based on review of five staff files, the training documents are in compliance, except there were missing documentation regarding administrator-specific training. At this time, the inspection is not complete and LPAs will return at a later date to continue the inspection. LPAs conducted an exit interview with Alvaro Zambrano at 1: PM and delivered one (1) Type B deficiency and one (1) technical violation. A copy of the report was discussed and provided to Alvaro Zambrano prior to leaving the facility.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 7/16/2024 at 10:31am, Licensing Program Analyst (LPA) Selena Hood and LPA Mona Lam conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the quarterly visit for the Non-Compliance Conference (NCC) initially conducted on 12/7/2023. LPAs met with Janelle Bush, Residential Supervisor. LPAs reviewed the staff schedule. The staff schedule had not been updated to reflect staffing changes, the facility staff was able to provide updated scheduled during the inspection. LPAs reviewed their nightly shift logs. LPAs reviewed that the overnight check-ins were done intermittently but no more than fifteen minutes apart in accordance with the NCC agreement. LPAs reviewed training records for five staff members. The facility had one client in care. LPAs reviewed one client file, including treatment plan, admission agreement, medication log, and bio-psychosocial exam. LPAs conducted one confidential interview. During the visit, LPAs were informed that the designated Administrator was transitioning to a position outside the home, but they would remain as the Administrator until the current residential supervisor had received their Administrator certification. During review of the client medication logs, LPAs reviewed that one client had received a new medication (M1) while in care that did not receive written parental authorization. This poses an immediate risk for the health, safety, and/or personal rights of clients in care. LPAs delivered a Type A citation for California Code of Regulations, Title 22, Chapter 5, 84070(b)(12)(a) Children's Records. The facility was previously cited with this regulation on 4/15/2024. LPAs assessed a civil penalty for $250 due to the repeat violations. During review of the nightly shift logs, LPAs were informed that one client had been taken to the hospital during the overnight shift on 7/3/2024. Based on review, an incident report was not submitted to Community Care Licensing (CCL). This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPAs delivered a Type B citation for California Code of Regulations, Title 22, 80061(b) Reporting Requirements. The facility was previously cited with this regulation on 8/21/2023. LPAs assessed a civil penalty for $250 due to the repeat violations. During the review of the client files, LPAs reviewed that one client had not received a signature on their treatment plan from their parent or authorized representative. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPAs delivered a Type B citation for California Code of Regulations, Title 22, Chapter 5, 84068.2(d)(1) Needs and Services Plan. The facility was previously cited with this regulation on 8/21/2023. LPAs assessed a civil penalty for $250 due to repeat violations. LPAs delivered appeal rights and conducted an exit interview with Janelle Bush, Residential Supervisor, and Levi Banks, Residential Supervisor, at 2:27pm. Janelle Bush's signature confirms the receipt of this document.

Deficiencies:
80061(b): 1
2
3
4
5
6
7

met_with: Janelle Bush

title:
1
2
3
4
5
6
7 80061(b) Reporting Requirements - Upon the occurrence, during the operation of the facility...  a written report... shall be submitted to the licensing agency within seven days following the occurrence of such event.
This requirement was not met as evidenced by

description:
1
2
3
4
5
6
7


summary: Facility Evaluation

raw_content:
Narrative:
On 10/02/24 at 11: AM, Licensing Program Analysts (LPAs) Mona Lam and Celeste Aparicio conducted an unannounced visit to the licensed facility listed above. The purpose of the visit is to conduct a quarterly non-compliance conference (NCC) initially conducted on 12/07/23. LPAs met with Alvaro Zambrano. LPAs were informed that a new administrator will eventually take place. There are currently three staff members working towards to their administrator certification. As of this time, there are no clients in care and no staffs working on site. The staff members are allocated to different Newport sites. LPAs reviewed two client files. The bio psychosocial exams were present and complete in the files. In addition, the authorized representative's signatures are documented for both needs and services forms and medication for youth to take. LPAs reviewed documentation of nightly check-in schedule and medication logs. LPAs observed staff schedule for August 2024. LPAs saw that the Administrator was included on the staff schedule and at least worked three days a week. LPAs observed house meeting notes on July 30, 2024, which documents incident report training. LPA Lam received board minutes via email dated on May 22, 2024. LPAs reviewed six staff files. Staff files have missing training regarding sexuality, health, and emotional development. LPAs delivered a Type B citation for California Code of Regulations, Title 22, Chapter 5, 84065(j)(3)(H) Personnel Requirements. LPAs conducted an exit interview with Alvaro Zambrano at 4: PM and delivered one (1) deficiency. In addition, LPAs delivered an appeals rights page. Alvaro Zambrano's signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/03/25 at 10: AM, Licensing Program Analysts (LPAs) Mona Lam and Kristin Pierotti conducted an unannounced inspection to the licensed facility listed above. The purpose of the visit is to continue a quarterly non-compliance conference (NCC) inspection. LPAs met with Alvaro Zambrano, Residential Manager. LPAs reviewed medication logs for five client files. Medication logs were in compliance. LPAs reviewed five staff files. Based on five staff files, the training documents are in compliance, except there were missing documentation regarding about health development, sexuality development, and emotional development. Newport Arena is currently working in compliance to document all staff training based on the citation given to Newport Arena on 10/02/2024. LPAs reviewed internal incident reports and observed multiple incidents that have not been reported to the department between December 2024 to January 2025. Based on assessment of compliance history within the last 12 months and observation, a deficiency was issued to the licensee for failure in sending written incident reports to the licensing agency on 02/03/25 under 80061(b) Reporting Requirements. As a result of the facility's repeat violation within the last 12 months, the facility will be issued a civil penalty for $1000.00 on 02/03/25 (refer LIC 421FC). LPAs conducted an exit interview with Alvaro Zambrano at 1: PM and delivered one (1) deficiency. A copy of the report, appeals rights, and civil penalty were discussed and provided to Alvaro Zambrano prior to leaving the facility. Report was amended on 02/25/25 and an exit interview was conducted with Elizabeth Jimenez.


facility_name: NEWPORT ACADEMY-ALBERCA

raw_content:
Investigation Findings:
13On 5/2/2023 at 9:00am, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced inspection to the above-listed facility, and met with the Facility Manager (FM). The purpose of this inspection is to deliver the finding on the complaint investigation regarding the above allegation. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegations. Record reviews and confidential interviews revealed that P1 was not listed on the LIC500 but was working and/or present within the facility prior to obtaining a criminal background clearance. Based on LPA's interviews which were conducted along with record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Based on California Code of Regulations, Title Regulations Division Chapter 1&5, a deficiency is being cited on the attached LIC 9099D and a civil penalty is being assessed. Exit Interview conducted, and a copy of this report was emailed to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: NEWPORT ACADEMY-ALBERCAFACILITY NUMBER: 565802317

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Bryce Nodelman, Facility Manager


raw_content:
Investigation Findings:
13On 08/11/2023 at 9:05am, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above listed facility, Newport Academy Group Home, for the purpose of concluding the investigation on the above allegation: (3) Licensee does not ensure direct care staff training topics are appropriate for the client population at facility. The investigation included confidential interviews with facility and administrative staff. Per LPA request of training records, which the Licensee provided; a review of the records revealed that training topics are few and not varied, and do not meet the minimum, regulatory requirement. Based on all interviews conducted, and documents obtained, the Department has found the above allegations to be substantiated, meaning that, the preponderance of the evidence has been met. The facility is issued a citation. The following deficiency was cited [See page LIC9099-D for cited deficiencies]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, and appeal rights were provided to the licensee. The report will be emailed to Facility Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION GREATER LA AREA SC, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: NEWPORT ACADEMY-ALBERCAFACILITY NUMBER: 565802317

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Sheryl Stone, HR Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 04/14/2021, the Licensing Program Analyst (LPA) Enrique Hernandez, made a call through Microsoft Teams to the facility and spoke with the facility Administrator (FA) Tiai.Salanoa . The purpose of this inspection is to see that the proper repairs have been made that LPA Hernandez had observed during the 3/16/ Pre licensing inspection. The following repairs have been made: In bedroom # 1 there is a pole for hanging clothes in the closet. The glass door of the fireplace next to the living room was repaired. The laundry sink was installed. The shower in room #3, the knobs work properly and water comes out. On the menu, in the breakfast section they added options for breakfast. Exit interview was conducted and a copy of this report will be emailed to the facility administrator, in order to obtain a signature. Signature will be on file.

visit_type: Prelicensing

met_with: Tiai Salanoa


summary: Facility Evaluation

raw_content:
Narrative:
On March 22, 2022, at 09:26AM Licensing Program Analysts (LPAs) Enrique Hernandez and Nancy O'Connell, conducted an unannounced inspection, with the purpose of conducting a Post licensing inspection. LPA Met with Tiai Salanoa Facility Administrator (FA), Bryce Nodelman (Lead Care Coordinator) , and Tone Reyes Program Director (PD). The Facility Administrator granted access to the facility and toured the facility together, inside and out. This is a two-story home 3 bedroom, 7 bathrooms 3 therapy room, a living room, dining room, kitchen, breakfast area, family room, garage, laundry area, and a backyard. There are no facility cameras on the premises. The staircase have access to the 2nd level of the home. There are no security bars on the windows. This facility will provide services to 6 female clients ages 12-17 years, ambulatory only. There is a swimming pool and jacuzzi located in the backyard covered with a net. Pool and jacuzzi is also surrounded by a gate with proper latching device that meets regulations. The LPAs observed the following: Living Room: with a securely covered fireplace with plenty of seating that has access to the backyard. Dining Room: equipped with a large table with 12 chairs. Kitchen: equipped with a refrigerator, cook top - Gas, Double Oven, Microwave, Breakfast Nook, Formal Dining Room, Kitchen Island a sink is located in the island, and plenty of cabinet space. Knives/ Sharp objects are not stored in the kitchen. Chemicals and cleaning solutions are kept in locked. Care Coordinator Office: Sharps stored in locked cabinet. Cont. on LIC 809-C Breakfast area: consists of a table with 8 chairs, Family Room: equipped with a secure cover on the fireplace, and plenty of clean furniture in good repair. Garage: locked, 4 garage spaces, equipped with a ping pong table, pool tale, punching bag, one treadmill, stationary bike and plenty of locked cabinets for storage. When you open the garage doors in front of it is a tennis court/basketball court. Laundry area: equipped with a washer and dryer, and plenty of cabinet space with a fully charged fire extinguisher. The laundry room sink is installed. Personal care items for clients are kept in upper locked cabinets. School: equipped with a fully charged fire extinguisher, smoke alarm, 6 desk, 10 chairs, a printer, Applicant reported that each client shall have access to his/her own laptop during school hours. 3 bedrooms each room is equipped with two small twin-size bed, each have bedroom have its own bathroom, with sufficient lighting, drawer and closet space, and clean lines, blankets, and pillows. Nursing station, where a first aid kit, and first aid supplies were observed. There is also a small refrigerator for storage of client medication that requires refrigeration. Group Therapy Rooms observed: · Counseling office: equipped with clean furniture in good repair. · Family Therapy room: equipped with furniture, and which will be used for clients. · Individual & Family Therapy Room: equipped with 4 chairs, a small coffee table, and one locked closet There are no firearms or dangerous weapons in the home. Medicines are inaccessible to children. All smoke detectors were tested and are operating properly in the home at the time of visit. There are numerous fully charged fire extinguishers available. Outdoor activity space free of obstructions. the water temperature in the clients' bedrooms and measured within safe temperature at 105degrees Fahrenheit during the time of the inspection. First aid kits were checked and complete with scissors, CONT. on LIC 809-C tweezers, thermometer, gauzes, antiseptic and 1st Aid Manual. All posting requirements for the Licensee's Private placement License and Emergency Plan will be met, aside from the Group Home License. There are covered fireplaces in the home, and it was stated by Bryce (Lead Care Coordinator) that they are not working. The Exterior consists of the following: The backyard also consists of the following: a fountain that is covered with dirt and it was indicated that they are going to plant plants in the fountain area, a built-in Bar-B-Que a table on the side with 12 chairs with a mountain view. LPA observed that the side perimeter gate does not fully close and a work order was requested and received by the LPA. Facility currently has two Toyota Siennas insured, that has the capacity to transport six (6) clients and is equipped with a fully charged fire extinguisher. Seat belts and lights and turn signals were found to be in good condition at the time of inspection. Fire Clearance was granted on February 18, 2021. Due to time constraints, LPA will return to review the client/staff files in order to complete the Post License Inspection. An Exit Interview was conducted with the Administrator and due to technical difficulties with the LPA's printer, LPA will email a copy of the report to the Facility Administrator.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 22, 2022, at 09: AM Licensing Program Analysts (LPAs) Enrique Hernandez and Nancy O'Connell, conducted an unannounced inspection, with the purpose of conducting an Annual/Required inspection. LPA Met with Tiai Salanoa Facility Administrator (FA), Bryce Nodelman (Lead Care Coordinator) , and Tone Reyes Program Director (PD). The Facility Administrator granted access to the facility and toured the facility together, inside and out. This is a two-story home 3 bedroom, 7 bathrooms 3 therapy room, a living room, dining room, kitchen, breakfast area, family room, garage, laundry area, and a backyard. There are no facility cameras on the premises. The staircase have access to the 2nd level of the home. There are no security bars on the windows. This facility will provide services to 6 female clients ages 12-17 years, ambulatory only. There is a swimming pool and jacuzzi located in the backyard covered with a net. Pool and jacuzzi is also surrounded by a gate with proper latching device that meets regulations. The LPAs observed the following: Living Room: with a securely covered fireplace with plenty of seating that has access to the backyard. Dining Room: equipped with a large table with 12 chairs. Kitchen: equipped with a refrigerator, cook top - Gas, Double Oven, Microwave, Breakfast Nook, Formal Dining Room, Kitchen Island a sink is located in the island, and plenty of cabinet space. Knives/ Sharp objects are not stored in the kitchen. Chemicals and cleaning solutions are kept in locked. Care Coordinator Office: Sharps stored in locked cabinet. Cont. on LIC 809-C Breakfast area: consists of a table with 8 chairs, Family Room: equipped with a secure cover on the fireplace, and plenty of clean furniture in good repair. Garage: locked, 4 garage spaces, equipped with a ping pong table, pool tale, punching bag, one treadmill, stationary bike and plenty of locked cabinets for storage. When you open the garage doors in front of it is a tennis court/basketball court. Laundry area: equipped with a washer and dryer, and plenty of cabinet space with a fully charged fire extinguisher. The laundry room sink is installed. Personal care items for clients are kept in upper locked cabinets. School: equipped with a fully charged fire extinguisher, smoke alarm, 6 desk, 10 chairs, a printer, Applicant reported that each client shall have access to his/her own laptop during school hours. 3 bedrooms each room is equipped with two small twin-size bed, each have bedroom have its own bathroom, with sufficient lighting, drawer and closet space, and clean lines, blankets, and pillows. Nursing station, where a first aid kit, and first aid supplies were observed. There is also a small refrigerator for storage of client medication that requires refrigeration. Group Therapy Rooms observed: · Counseling office: equipped with clean furniture in good repair. · Family Therapy room: equipped with furniture, and which will be used for clients. · Individual & Family Therapy Room: equipped with 4 chairs, a small coffee table, and one locked closet There are no firearms or dangerous weapons in the home. Medicines are inaccessible to children. All smoke detectors were tested and are operating properly in the home at the time of visit. There are numerous fully charged fire extinguishers available. Outdoor activity space free of obstructions. the water temperature in the clients' bedrooms and measured within safe temperature at 105degrees Fahrenheit during the time of the inspection. First aid kits were checked and complete with scissors, CONT. on LIC 809-C tweezers, thermometer, gauzes, antiseptic and 1st Aid Manual. All posting requirements for the Licensee's Private placement License and Emergency Plan will be met, aside from the Group Home License. There are covered fireplaces in the home, and it was stated by Bryce (Lead Care Coordinator) that they are not working. The Exterior consists of the following: The backyard also consists of the following: a fountain that is covered with dirt and it was indicated that they are going to plant plants in the fountain area, a built-in Bar-B-Que a table on the side with 12 chairs with a mountain view. LPA observed that the side perimeter gate does not fully close and a work order was requested and received by the LPA. Facility currently has two Toyota Siennas insured, that has the capacity to transport six (6) clients and is equipped with a fully charged fire extinguisher. Seat belts and lights and turn signals were found to be in good condition at the time of inspection. Fire Clearance was granted on February 18, 2021. Due to time constraints, LPA will return to review the client/staff files in order to complete the Post License Inspection. An Exit Interview was conducted with the Administrator and due to technical difficulties with the LPA's printer, LPA will email a copy of the report to the Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On October 23, 2023 at 1:45pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the above listed facility and was met by the Lead Care Coordinator (LCC). The purpose of the visit was to conduct a collateral interview, in regards to a complaint at another licensed facility. LPA Wilson conducted confidential interviews with (C5 and CD) [See LIC811 dated 10/23/2023 for a list of confidential names.] There are no deficiencies to be cited at this time. A copy of this report was emailed to the facility.

met_with: Lead Care Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Residential Supervisor, Lahni Salanoa and Compliance Specialist Regan Mew to conduct the annual random inspection. The following was observed: This is a three bedroom home, with 3 therapy rooms and 7 bathrooms. There is also a classroom that doubles as a study room and a garage that doubles as a rec room. The home serves minors placed by their parents. There are currently 6 male clients assigned to the 3 bedrooms. There are no security bars on windows. The pool and jacuzzi are enclosed behind a mesh gate that is key locked. There are smoke detectors and carbon monoxide detectors in the home. LPA observed several fully charged fire extinguishers. The fireplace is securely gated. Kitchen and bathroom areas are well maintained. Food supply meets Title 22 requirements. Hot water temperature is within a safe range. All medications, knives and household cleaners are safely stored in locked areas. There are several first kits in the home and in the facility van. However there is no first aid manual. LPA reviewed the restraint log for the year. So far there has been only one restraint. The last disaster drill was conducted on 01/05/24 and documented in the log. LPA viewed the facility van for working safety equipment. All bedrooms have two twin beds with the required linens in good condition. There is the required drawer and closet space for each bedroom, The following items were posted and current: Notice of client rights, notice of employee rights, floor plan, menu. LPA will return on 03/12/24 to complete staff and client record reviews and interviews.

met_with: Lahni Salanoa, Residential Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 5/25/23, at 1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced Case Management- deficiencies inspection to the above-listed facility. LPA was met by the Residential Supervisor who provided access to the facility. On 5/17/23, the Department received information that an unapproved alteration was made to the physical environment of the facility. Specifically, the therapy office located on the first floor was converted into a client bedroom, and the adjoining fire exit door was locked, preventing free access to exit the facility in the event of an emergency. Evidence of the violation is retained in Department records. On 5/18/23, Licensing Program Analyst (LPA) Nancy O'Connell and Licensing Program Manager (LPM) Kevin Sauk contacted the Residential Program Manager (RPM), Mydori Saipale to inquire about the alteration made to the door in the therapy office/client bedroom. LPM asked if the door was altered to prevent free access to exit, and RPM explained that the could still be exited and had not be changed to prevent free access.LPM informed RPM that if that emergency exit door in the therapist office has a lock requiring a key, it would need to be removed immediately. RPM agreed. During the inspection on 5/25/23, LPA conducted a walk through of the facility with S1 and upon inspection of the pool area, LPA and S1 observed the pool gate to be open, allowing access to the pool and spa. Further, the pool gate door is set up to swing inward towards the pool. Lastly, LPA walked the perimeter of the pool gate and observed the mesh gate panels to be non-secure, allowing for hooks to be unlatched, and providing access to the pool. S1 observed gate and agreed that the pool is accessible to clients. LPA inquired about reason for gate not being secured and S1 stated she wasnt sure why the gate was not secured and believed maintenance reinstalled the gate incorrectly. LPA retained photos for evidence and informed S1 that a deficiency would be cited. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, there are three deficiencies to be cited at this time. See LIC809D for detials. An exit interview was conducted, and a copy of this report was discussed and emailed to the licensee.

met_with: Autumn Fritz, Staff Lead (S1) , Regan Mew, Complaince Specialist (CS), Tiai Salanoa, Residential Supervisor (RS).


summary: Facility Evaluation

raw_content:
Narrative:
On August 11, 2023 at 9:30am, Licensing Program Analyst (LPA) Christine Wilson met with the above facility, to conduct a case management deficiency. During the complaint investigation control ID# 31-CR-20230509115043 it was revealed that the licensee does not document training hours for each training. The following deficiencies were identified and the facility is issued a citation [See page LIC809-D for cited deficiencies]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, and appeal rights were provided to the licensee. This report will be emailed to Facility Administrator