306005154-4-14-2023-22-AS-SSAS-CRAPV5-20230427113833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005154
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:15:51 PM

Unfounded

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
02/27/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230227164107

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:	04/14/2023
		UNANNOUNCED	TIME BEGAN:	04:01 PM
MET WITH:	Erin Rehbein, Director of Marketing Stephanie Garcia Rios, Wellness Director Rogelio Martinez, Maintenance Director Michelle Goodney, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are unable to communicate due to language barrier

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to deliver findings into the investigation of the allegation listed above. LPA was greeted and granted entry by facility staff. Administrator Michelle Goodney was notified of the visit and arrived later to assist.

An initial visit was conducted on March 6, 2023. Staff schedule reviewed, staff interviews conducted. Based on documents reviewed and staff interviews, staff member S1 was confirmed to be present on the day reported in the initial complaint report. S1 was confirmed by interview to be fluent in English. The allegation is therefore Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

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

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: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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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