306005154-3-6-2023-22-AS-SSAS-CPRTP2-20230309135335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005154
Report Date: 03/06/2023
Date Signed: 03/06/2023 04:55:17 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
12/28/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221228101134

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:	03/06/2023
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Michele Goodney, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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2/ Facility heater units are in disrepair

3/ Facility is operating without an Administrator

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 of the allegatons listed above as well as to deliver findings to the licensee.

An initial investigation visit was conducted at the facility on January 4, 2023. A tour of the physical plant was conducted with the administrator and a sample of units on both floors were observed. The room's individual thermostats and HVAC units were tested. Records were requested and reviewed, including the resident census, LIC500 Personnel Report (LIC500), staff schedule for a two-week period starting on November 27, 2022, staff payroll records and a sample of six resident files on record. A type B violation was documented as part of a case management visit the same day.

LPA conducted a follow up visit on January 17, 2023 after additional concerns regarding staffing were brought to the attention of the Department. (CONTINUED ON FORM LIC9099-C)

Substantiated

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: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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 5

Control Number 22-AS-20221228101134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NEWPORT BEACH MEMORY CARE	FACILITY NUMBER: 306005154
	VISIT DATE: 03/06/2023

NARRATIVE

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(CONTINUED FROM FORM LIC9099) During the visit, LPA toured the two levels of the facility again and observed staffing levels to be in accordance with documented staffing goals for the facility. Records reviewed included past schedules which demonstrated adequate staff coverage for the three daily shifts. An additional tour of the physical plant was conducted on February 3, 2023 as part the complaint investigation referenced 22-AS-20230131162326. HVAC units were all observed to be functional at that point and temperatures were observed. A final facility visit was conducted on March 6, 2023. A tour of the physical plant was conducted and eight staff interviews were conducted by LPA during the visit.

Regarding the allegation that Facility heater units are in disrepair, the following was concluded: At some time towards the end of Summer 2022 and the beginning of Winter 2022, multiple staff stated in interviews that individual heater units were dysfunctional and were temporarily replaced by electric floor heaters that had been ordered by the previous leadership team. Upon conducting the initial inspection visit, LPA was informed by the new leadership team that repairs were under way and have now been completed. Individual units are observed to be functional at the time of the present visit. A majority of accounts confirmed the statement, therefore the allegation is deemed to be Substantiated, meaning the preponderance of evidence standard has been met.

Regarding the allegation that Facility is operating without an Administrator, the following was concluded: Around Thanksgiving 2022, the former executive director held an all-hand meeting to informally announce to staff the possibility that she might leave the facility. Over the following weeks, both the Executive Director and the previous Wellness Director became increasinly prone to being absent from the facility without HR or front desk staff being informed. No official notice of a last day at the facility or notice of delegated administrator responsibilities were issued by the licensee, leaving facility staff to improvise procedures to keep major facility functions operational. This lasted for several weeks until the current administrator was hired and onboarded on December 19, 2022. A majority of accounts confirmed this version of events, therefore the allegation is deemed to be Substantiated, meaning the preponderance of evidence standard has been met.

Two citations were issued on an attached form LIC9099-D. An exit interview was conducted and a copy of this report along with appeal rights were provided to 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: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
12/28/2022 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221228101134

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:	03/06/2023
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Michele Goodney, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are insufficient in numbers to meet resident needs

INVESTIGATION FINDINGS:

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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: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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 5

Control Number 22-AS-20221228101134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NEWPORT BEACH MEMORY CARE	FACILITY NUMBER: 306005154
	VISIT DATE: 03/06/2023

NARRATIVE

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During the visit, LPA toured the two levels of the facility again and observed staffing levels to be in accordance with documented staffing goals for the facility. Records reviewed included past schedules which demonstrated adequate staff coverage for the three daily shifts.

An additional tour of the physical plant was conducted on February 3, 2023 as part the complaint investigation referenced 22-AS-20230131162326. A final facility visit was conducted on March 6, 2023. A tour of the physical plant was conducted and eight staff interviews were conducted by LPA during the visit.

Regarding the allegation that Staff are insufficient in numbers to meet resident needs, the following has been concluded: Starting with the leadership team transition period in November/December and disruption in the chain of communication for staff calling out, difficulties with staffing occurring more often, causing staff to have to stay on overtime to ensure coverage goals were met. Additional hires were implemented to progressively remedy the amount of private agency staff the facility had to rely on. Multiple reviews of clock-ins and schedules demonstrated that the minimum targeted amount of staff were present at the facility. The allegation is therefore found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided and left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20221228101134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NEWPORT BEACH MEMORY CARE	FACILITY NUMBER: 306005154
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/06/2023 Section Cited CCR 87405(a)	1 2 3 4 5 6 7	The California Code of Regulations Section 87405(a) Administrator - Qualifications and Duties states that: "(...) When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible."	1 2 3 4 5 6 7	A replacement administrator was hired and started employment on December 19, 2023. However, licensee will make sure that a qualified administrator is designated for coverage should another instance of prolonged absence occur.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews conducted and records reviewed, when the former Administrator's resignation, no official designation of responsibility was made. This deficiency posed a potential risk to the health, safety and personal rights of individuals in care	8 9 10 11 12 13 14
Type B 03/06/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	The California Code of Regulations Section 87303(a) on Maintenance and Operation states that: "The facility shall be (...) in good repair at all times." This requirement was not met as evidenced by: Based on interviews conducted, an unspecified number of individual heating units	1 2 3 4 5 6 7	At the time the Substantiated findings were delivered, facility had already completed the required repairs and the entire facility was observed to be in compliance with mandated temperatures. The Plan of Corrections is considered to be cleared at this time.
	8 9 10 11 12 13 14	were stated to have been non-functional, causing the previous administrator to provide heat by means of unauthorized floor heating units that were later removed before heating was repaired. This deficiency posed a potential risk to the health, safety and personal rights of individuals in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

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