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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003919
Report Date: 05/18/2022
Date Signed: 05/19/2022 06:53:42 AM


Document Has Been Signed on 05/19/2022 06:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:NEWPORT SENIOR LIVINGFACILITY NUMBER:
306003919
ADMINISTRATOR:BRUCE WINSTEADFACILITY TYPE:
740
ADDRESS:425 RIVERSIDE AVENUETELEPHONE:
(949) 574-4826
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92663
CAPACITY:6CENSUS: 6DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Maria Ordonez and Bruce WinsteadTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility and explained the reason for the visit. Licensee Bruce Winstead arrived during the visit.

At 9:58 AM, LPA toured the facility with Licensee Winstead. Facility has 6 residents in care during today's visit with 4 on hospice. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements as well as restrooms stocked with soap/ sanitizer and paper towels. All rooms are single occupancy with private restroom. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the facility. Facility utilizes a visitor sign in sheet. Facility takes resident and staff temperatures daily and documents results. LPA observed ample sanitizer spread out throughout the facility. Facility has covid precaution postings as well as all required department postings. Administrator Chris Landon has an administrator certificate expiring on 12/27/2023. Facility has completed the mitigation plan and LPA observed the emergency disaster plan posted in facility as well. LPA observed a seven day supply of emergency food and water stored in the garage. Smoke detectors tested operational during today's visit and fire extinguishers were fully charged. LPA toured the outside grounds and observed multiple shaded outside visitation areas. Exit gates are unlocked. LPA observed the locked medication storage area. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed all resident files during the visit and all files are up to date. All staff and residents are vaccinated for Covid-19.
LPA consulted with Licensee regarding the importance of maintaining a 30 day supply of N95 masks on-site at all times.
No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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