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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005449
Report Date: 10/11/2022
Date Signed: 10/11/2022 04:47:21 PM


Document Has Been Signed on 10/11/2022 04:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:ATRIA NEWPORT PLAZAFACILITY NUMBER:
306005449
ADMINISTRATOR:GONZALEZ, JOHANNAFACILITY TYPE:
740
ADDRESS:1455 SUPERIOR AVETELEPHONE:
(949) 645-6833
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92663
CAPACITY:160CENSUS: 94DATE:
10/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Johanna Gonzalez, Executive DirectorTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced case management visit to follow up on an incident report submitted on 10/03/2022 to the Department. LPA identified himself and was greeted and and granted entry by Executive Director Johanna Gonzalez after explaining the purpose of the visit.

An incident report and a Report of Suspected Dependent Adult/Elder Abuse (Form SOC341) both dated 10/03/2022 indicate that on 09/29/2022 at approximately 5:00pm, Resident 1's sister reported $600 missing from R1's purse. Newport Beach police department was called and a case was created under reference number #2209290163. Officer said this is being documented only at this time. R1's sister was in the community when the officers were called.

Executive Director states that no other similar complaint have been recorded at this time. Resident has frequent outside visitors and facility has no suspicion on a potential perpetrator. Family was advised to avoid leaving large sums of cash in the resident's bedroom.

LPA interviewed resident R1 privately in the facility's library to gather their account of the incident.

No citations noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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