306005449-1-13-2025-22-AS-KSGH-DCW2RM-20250113163745

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005449
Report Date: 01/13/2025
Date Signed: 01/13/2025 04:42:58 PM

Document Has Been Signed on 01/13/2025 04:42 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 PLAZA		FACILITY NUMBER:	306005449
ADMINISTRATOR/ DIRECTOR:	GONZALEZ, JOHANNA		FACILITY TYPE:	740
ADDRESS:	1455 SUPERIOR AVE		TELEPHONE:	(949) 645-6833
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92663
CAPACITY: 160	TOTAL ENROLLED CHILDREN: 0	CENSUS: 111	DATE:	01/13/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:35 AM
MET WITH:	Johanna Gonzalez, Executive Director Karla Arteaga, Community Business Director		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On this day, Licensing Program Analysts (LPA) Kevin Saborit-Guasch and Hanna Gough made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were greeted and granted entry after introducing themselves and the purpose of the visit to front desk staff. Executive Director Johanna Gonzalez was notified of the visit via telephone and could not assist with the visit in person. Licensing staff received the assistance of Business Office Director Karla Arteaga. LPAs requested and reviewed the facility's resident census, staff roster, Emergency and Disaster Plan, COVID-19 Mitigation Plan. Infection Control Plan is not present. Technical Violation Advisory Note provided along with a copy of licensing form LIC9828. A sample of nine staff records and eleven resident records were reviewed during the visit. There are 111 residents admitted at the time of the visit, five of which are receiving hospice care. 14 of these 111 residents are admitted to the Memory Care unit. Resident and staff records were confirmed to include all necessary components per Title 22 regulations. All staff members are confirmed to have adequate background clearance and association status in Guardian. Proof of training were provided and confirmed staff members met the minimum initial and annual training requirements. 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 third floor is approved for ambulatory only. All residents records reviewed for the third floor confirmed residents ambulatory status. LPAs accompanied by facility maintenance staff conducted a tour of the interior and exterior of the physical plant. A total of eleven units were visited and reviewed throughout the facility. Rooms were observed to be equipped with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floors and/or tiling. Hot water was measured in a total of twelve locations at faucets delivering hot water for grooming purposes. Water was systematically observed to be within the acceptable temperature range. CONTINUED ON FORM LIC809-C

Sheila Santos	TELEPHONE: (714) 334-2062
Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
	DATE: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 PLAZA	FACILITY NUMBER: 306005449
	VISIT DATE: 01/13/2025

NARRATIVE

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CONTINUED FROM FORM LIC809
LPAs and staff additionally toured the facility kitchen. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Emergency food and water supply observed in the facility's food storage.

Medications, cleaning supplies, and sharp items were inaccessible to residents in care in the memory care unit. Memory Care kitchen was reviewed for dangerous items, all of which are secured in locked cabinets. LPAs reviewed the physician orders and contents of two of the facility's medication cart. Memory care medication cart was additionally verified to be locked when not attended. One resident whose records were reviewed was determined to have been assessed to be unable to manage their self-administered medication. Resident is verified to be on Medication Management per review of the electronic Medication Administration Records. However prescription ointments and over-the-counter supplements are observed in the resident's bathroom during the walk-through. Type B citation issued.

Sprinkler system and fire safety systems were inspected respectively in September and August 2024 with no deficiency or disfunctional equipment noted. All mounted fire extinguishers throughout the facility are confirmed to be fully charged. Carbon monoxide detectors are located in multiple locations on each of the three levels.

For the exterior portion, facility has a central courtyard with a patio. The second level has a balcony with sturdy railing above the inside courtyard. Finally, there is a rooftop outdoor area with ample outdoor furniture and shade on the facility's top level. The memory care unit has a separate courtyard with secure egress, furniture and shade also which is accessible through multiple doors leading out of the unit. Delayed egress is in place as approved in the facility and ample quantity of outdoor furniture and activity materials are present. Activities are observed to be in progress in the memory care during the walk-through. The routes of egress were free of tripping hazards and the exit gates were self-latching and functional. Licensee agreed to submit proof of liability insurance via email at the earliest convenience.

One type B deficiency is cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights was 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: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/13/2025 04:42 PM - It Cannot Be Edited

Created By: Kevin Saborit-Guasch On 01/13/2025 at 04:17 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: ATRIA NEWPORT PLAZA	FACILITY NUMBER: 306005449
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87465(a)(4)

Per California Code of Regulations Section 87465(a)(4) regarding Incidental Medical and Dental Care: "The licensee shall assist residents with self-administered medications as needed." This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above as prescription ointments and over-the-counter supplements are observed in the bathroom of resident R1, in spite of R1 status under medication management and latest assessment. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/20/2025
	Plan of Correction
1 2 3 4	Due to the resident's assessment status, medications and supplements will need to be placed into the medication central storage by the plan of corrections due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 01/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2025

LIC809 (FAS) - (06/04)

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