306004302-10-7-2020-22-AS-SSAS-BUK3SH-20201019183019

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004302
Report Date: 10/07/2020
Date Signed: 10/07/2020 01:34:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/26/2020 and conducted by Evaluator James August

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200626115912

FACILITY NAME:	NEWPORT SENIOR LIVING III		FACILITY NUMBER:	306004302
ADMINISTRATOR:	BRUCE WINSTEAD		FACILITY TYPE:	740
ADDRESS:	2412 HOLLY LANE		TELEPHONE:	(714) 351-7800
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92663
CAPACITY:	6	CENSUS: 6	DATE:	10/07/2020
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Administrator (AD) Chris Landon		TIME COMPLETED:	01:33 PM

ALLEGATION(S):

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Staff refused to respond to residents’ calls for assistance
Staff denied residents food.
Staff handled residents in a rough manner.
Staff make inappropriate comments towards residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jim August contacted the facility via telephone to conclude a complaint investigation via telephone due to COVID-19 and precautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the allegations with Administrator Chris Landon.
The 10-day facility visit was completed on July 1, 2020.

The investigation into the allegations that the staff refused to respond to residents’ calls for assistance, staff denied residents food, staff handled residents in a rough manner and staff make inappropriate comments towards residents revealed the following:

LPA August conducted the initial facility visit on July 1, 2020 and subsequent visit on July 28, 2020. LPA August conducted interviews with Witness 1 (W1), Administrator Chris Landon, seven (7) staff members, three (3) residents and obtained and reviewed records from the facility. LPA August interviewed Witness 1 (W1) on July 1, 2020. CONTINUED ON LIC9099C DATED OCTOBER 7, 2020...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20200626115912

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 LIVING III	FACILITY NUMBER: 306004302
	VISIT DATE: 10/07/2020

NARRATIVE

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W1 witnessed other staff members refusing to respond to residents calls for assistance, refusing food to the residents, handling residents in a rough manner and making inappropriate comments towards residents.

On July 6, 2018 LPA interviewed Staff 1 (S1) and Staff 2 (S2). LPA August interviewed Staff 3 (S3), Staff 4 (S4), Staff 5 (S5) Staff 6 (S6) and Staff 7 (S7) on July 8, 2020. All seven staff members denied ever committing the above allegations or witnessing any other staff member commit said allegations.
On July 28, 2020 LPA August interviewed Residents 1 (R1), 2 (R2) and 3 (R3). All three residents denied the above allegations. In addition, all three residents have never seen any staff member commit said allegations to any other resident at the facility.

As such, there is insufficient evidence to corroborate whether the above allegations have occurred. With the information obtained through the means described above, we have found the above allegations unsubstantiated. Although the allegations may have happened or may be valid; there is not a preponderance of evidence to prove that the alleged violations occurred. No deficiencies were observed, and no citations were issued during this visit.

An exit interview was conducted with Administrator Chris Landon via tele-visit and a copy of this report was provided to Administrator Landon via email. Administrator Landon to sign all pages of the report and return the signed copy to LPA August within 24 hours.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: James August	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC9099 (FAS) - (06/04)

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