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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005449
Report Date: 04/24/2024
Date Signed: 04/24/2024 05:25:06 PM


Document Has Been Signed on 04/24/2024 05:25 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
ORANGE COUNTY RO, 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: 107DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Johanna GonzalezTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Executive Director Johanna Gonzalez and explained the reason for the visit. LPA observed the See Something, Say Something poster (PUB 475) posted in the entryway of the facility. The Executive Directors Administrator's Certificate expires January 18, 2025. Facility is a three story building with 112 resident rooms. Resident rooms are on all three floors. Memory care is on the first floor and has 12 rooms. The memory care unit has 2 delayed egress exits that are operational. Facility has a capacity for 160 non-ambulatory residents. The third floor is approved for ambulatory only. Hospice waiver is approved for 25 residents and no bedridden. LPA and the Executive Director toured the facility. LPA observed that all fire extinguishers throughout the facility are fully charged. The memory care unit is secured and requires a code to enter. The memory care unit has a dining room and activity room. LPA observed that all resident rooms in memory care had the required furnishings and bed linens. No obstacles or hazards observed in the memory care unit. LPA observed that there is an emergency evacuation chair at the top of each stairwell. LPA observed that in the 7 resident rooms inspected in assisted living, all the rooms had the required furnishings. LPA observed that all resident bathrooms that were inspected were clean and operational. Hot water in the bathrooms inspected measured from 107.0 degrees Fahrenheit to 112.4 degrees Fahrenheit. LPA observed the kitchen is clean and organized. LPA observed the temperature logs are posted on the refrigerators. LPA observed there is a 2 day supply of perishable and a 7 day supply of non-perishable food on hand in the kitchen. Both the memory care unit and the assisted living section have outdoor patio areas with shade for the residents to sit outside. No obstacles or hazards observed in the assisted living section of the facility. LPA observed the emergency food and water is stored on the third floor in a storage room. LPA interviewed staff and residents. LPA reviewed 10 staff files. No discrepancies observed. The 7 care staff files reviewed had the required training documented. LPA reviewed 10 resident files, no discrepancies noted. LPA reviewed resident medications, no discrepancies noted. The last fire drill was conducted on April 19, 2024. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided to the Executive Director.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
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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