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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005449
Report Date: 04/28/2023
Date Signed: 04/28/2023 11:35:21 AM


Document Has Been Signed on 04/28/2023 11:35 AM - 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: 91DATE:
04/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Johanna GonzalezTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Claudia Gutierrez conducted an unannounced case management visit to follow up on an incident report submitted on 04/25/2023 to the Department. LPA met with Executive Director (ED) Johanna Gonzalez and explained the purpose of the visit.

Incident report dated 04/25/2023 indicate that on 04/25/2023 at approximately 11:00 a.m., Resident 1 (R1) reported that a former employee was having sexual relations with other female residents. ED stated that employee had resigned on 02/09/2023 to join the Coast Guard and that no other resident had report any such incident.

LPA interviewed R1 privately in their bedroom to gather their account of the incident. R1 stated that the former employee had not had sexual relations with them or any other resident that they are aware of. R1 stated former employee had “great customer service” and stated they would be “comfortable” employing them in their own home. LPA interview six additional residents. Six out of six residents were unable to corroborate the incident and stated they have not witnessed nor heard of any such incident taking place. LPA also interviewed three staff. Three out of three staff were also unable to corroborate the incident and stated they have not witnessed nor heard of any such incident taking place.

R1 met with Primary Care Physician (PCP) on today’s date at approximately 10:00 a.m. LPA was provided with a current copy of Physician Report (LIC602) dated today’s date and R1’s Psych Evaluation dated 4/16/2023.

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: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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