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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005449
Report Date: 11/22/2021
Date Signed: 11/22/2021 02:18:36 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/12/2021 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-NP-20211112125130
FACILITY NAME:ATRIA NEWPORT PLAZAFACILITY NUMBER:
306005449
ADMINISTRATOR:GONZALEZ, JOHANNAFACILITY TYPE:
740
ADDRESS:1455 SUPERIOR AVETELEPHONE:
(949) 645-6833
CITY:NEWPORT BEACHSTATE: ZIP CODE:
92663
CAPACITY:160CENSUS: 97DATE:
11/22/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Johanna GonzalezTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Facility is wrongfully evicting Resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA identified herself and discussed the purpose of the visit with Executive Director Johanna Gonzalez.
During the course of the investigation, LPA interviewed staff and resident as well as reviewed and obtained pertinent documentation such as physician report and facility notes. Regarding the allegation that facility is wrongfully evicting resident, the investigation revealed the following: On 11/07/2021, Resident 1 (R1) eloped out of the facility with three other residents to go for a walk. The residents were observed on the front patio of facility by staff and redirected back into the facility. Per physician report, R1 is unable to leave the facility unassisted. R1 is diagnosed with Dementia. Facilty staff advised R1's responsible party that R1 would need to be moved into a memory care unit due to the elopement and documented decline. Facility memory care unit does not have any current openings and responsible party was given options at other Atria facilities that have openings. Family declined those options and R1 was put with a one on one caregiver until the resident could be admitted into a memory care. Facility does not utilize wander guards. CONTINUED ON LIC 9099C DATED 11/22/2021
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-NP-20211112125130
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
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 PLAZA
FACILITY NUMBER: 306005449
VISIT DATE: 11/22/2021
NARRATIVE
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Executive Director as well as Resident Services Director both deny giving out any timeline for relocation or a written eviction notice. Both state advising responsible party prior that R1 was declining and would have to be moved to a memory care unit at some point. Facility documentation confirms those conversations. Responsible party confirms not receiving an eviction notice from the facility. Therefore, the allegation is deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
LIC9099 (FAS) - (06/04)
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