306005154-8-17-2023-22-AS-AORZ-CVNTE9-20230914143931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005154
Report Date: 08/17/2023
Date Signed: 08/17/2023 02:11:47 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
08/09/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230809163155

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: 19	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	11:31 AM
MET WITH:	Kevin Fox, Operations Manager		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility administrator does not have proper qualifications

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 following up on the investigation into the allegation listed above. LPA was greeted and granted entry by the facility's Operations Manager after stating the purpose of the visit.

An initial investigation visit was conducted on August 14, 2023. Following the resignation of former Executive Director S1, the licensee has designated S2 as the new Operations Manager for the facility. At the time of the initial visit, S2 is confirmed to not be in possession of an active Administrator certificate.

Documentation provided during the present follow-up investigation visit demonstrated that S1 was on payroll for the facility until August 15, 2023 included. Starting August 16, 2023, an interim supervising administrator (S3) was named and was confirmed by LPA to be in possession of an active administrator certificate.

CONTINUED ON FORM 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: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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-20230809163155

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: 08/17/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Until Operations Manager S2 is able to complete the initial training to become a certified Residential Care Facility for the Elderly (RCFE) Administrator, it is stated that he will operate under the guidance and supervision of the current active certification holder. As a result of this investigation, the allegation that Facility administrator does not have proper qualifications is 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.

A consultation on the requirements for the presence of a certified administrator was provided to the facility's representative through a Technical Assistance Advisory Note, in an attached form LIC9102 as a corroborated lapse in the presence of an administrator within twelve months of a previous citation for failure to comply with Section 87405(a) of the California Code of Regulations issued on March 6, 2023 would constitute a repeat violation associated with an immediate civil penalty in the amount of $250.

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: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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