306005154-8-29-2023-22-AS-AORZ-CV8SRH-20230831140621

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005154
Report Date: 08/29/2023
Date Signed: 08/29/2023 03:14:40 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
08/24/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230824164013

FACILITY NAME:	NEWPORT BEACH MEMORY CARE		FACILITY NUMBER:	306005154
ADMINISTRATOR:	HADLEY, BRIAN		FACILITY TYPE:	740
ADDRESS:	1000 HALYARD		TELEPHONE:	(949) 220-9700
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92663
CAPACITY:	42	CENSUS: 20	DATE:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Kevin Fox, Operations Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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One of the facility's routes of egress is in disrepair

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegation listed above. LPA was greeted and granted entry by the facility's Operations Manager before listing the allegation.

LPA accompanied by Operations Manager toured the facility's physical plant and the exits leading away from the ground level's living units. All doors observed are equipped with a digital pad used to disable the sound alarm in place to alert staff of the exit being used. Signage indicating delayed egress systems being in use is also observed on exit doors. There are two routes of egress leading from the memory care area on the first level using a delayed egress. Both have been tested during the visit, with the bar being pushed for the required amount of time and the corresponding sound alarm being witnessed locally and at a central console. The facility staff was unaware of the test being conducted and the response observed was appropriate in terms of location and delay.
CONTINUED ON LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
08/24/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230824164013

FACILITY NAME:	NEWPORT BEACH MEMORY CARE		FACILITY NUMBER:	306005154
ADMINISTRATOR:	HADLEY, BRIAN		FACILITY TYPE:	740
ADDRESS:	1000 HALYARD		TELEPHONE:	(949) 220-9700
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92663
CAPACITY:	42	CENSUS: 20	DATE:	08/29/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Kevin Fox, Operations Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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9

Inoperant alarm has allowed unsupervised exits from residents with dementia

INVESTIGATION FINDINGS:

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13

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegation listed above. LPA was greeted and granted entry by the facility's Operations Manager before listing the allegation.

LPA accompanied by Operations Manager toured the facility's physical plant and the exits leading away from the ground level's living units. All doors observed are equipped with a digital pad used to disable the sound alarm in place to alert staff of the exit being used. Signage indicating delayed egress systems being in use is also observed on exit doors. There are two routes of egress leading from the memory care area on the first level using a delayed egress. Both have been tested during the visit, with the bar being pushed for the required amount of time and the correspoding sound alarm being witnessed locally and at a central console. The facility staff was unaware of the test being conducted and the response observed was appropriate in terms of location and delay.
CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20230824164013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: NEWPORT BEACH MEMORY CARE	FACILITY NUMBER: 306005154
	VISIT DATE: 08/29/2023

NARRATIVE

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CONTINUED FROM LIC9099-A

LPA conducted or attempted a total of six staff interviews during the investigation visit.

Regarding the allegation that an Inoperant alarm has allowed unsupervised exits from residents with dementia, the following has been concluded: Based on observation and interviews conducted, the sound alarms are functional and staff response is consistent with the prevention of wandering risks in the facility's residents. None of the staff members interviewed corroborated the occurrence of an incident during which any resident was able to exit the facility unsupervised. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 22-AS-20230824164013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: NEWPORT BEACH MEMORY CARE	FACILITY NUMBER: 306005154
	VISIT DATE: 08/29/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

LPA conducted or attempted a total of six staff interviews during the investigation visit.

Regarding the allegation that One of the facility's routes of egress is in disrepair, the following has been concluded: Based on the observation conducted during the tour of the physical plant, the delayed egress systems on both exit routes are operational. The gate only opens after a push on the bar for 15 seconds, immediately triggering an alarm at a central location alerting staff to the egress attempt. On both instances, facility staff was witnessed to intervene immediately to ensure no resident was able to exit the facility unsupervised. The exit gate between the secure outdoor space behind the facility and the parking was also confirmed to trigger a remote alarm but somehow did not sound locally. The allegation is therefore found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. The Department has investigated this complaint.

LPA provided a consultation on the regulatory requirements specific to dementia care documented in an attached Technical Assistance Advisory Note. Due to the presence of two large items in front of the backside egress gate, later easily repositioned away from the gate by facility staff, a Technical Violation Advisory Note regarding the requirements of the California Code of Regulations Section 87307(d)(6) was issued and a consultation provided to facility representative.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC9099 (FAS) - (06/04)

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