306005789-1-21-2021-22-AS-KLYN-BXGT3K-20210121132228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005789
Report Date: 01/21/2021
Date Signed: 01/21/2021 01:22:34 PM

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 BEACH		FACILITY NUMBER:	306005789
ADMINISTRATOR:	RODNY, BENJAMIN		FACILITY TYPE:	740
ADDRESS:	393 HOSPITAL ROAD		TELEPHONE:	(502) 779-4700
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92663
CAPACITY:	195	CENSUS:	DATE:	01/21/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ben Rodny		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Kimberly Lyman contacted the facility via telephone to conduct a pre-licensing visit via FaceTime due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call with Executive Director Ben Rodny. An initial application to operate a Residential Facility for the Elderly was received by CCL on 07/07/2020 for a capacity of 195 non-ambulatory residents of which 10 may be bedridden. Facility provides 43 resident rooms on the first floor and 42 rooms on the second floor. Rooms are a mix of studio, one, and two bedroom spaces. LPA observed all covid precautions were in place including proper signage, sanitizing stations, and sign in area/symptom check at entrance. LPA Lyman along with Executive Director Ben Rodny, Project Manager Jordan Pope, Senior Vice President Sarah Laloyan, Digital Innovation Director Dori Redman and Assistant Executive Director George Gonzalez toured the facility via FaceTime at 9:10 AM and observed the following: Structure: Facility is a three story, newly renovated building housing a restaurant, bistro, private dining area, mail room, common area, resident rooms, administrative offices and courtyard on the main floor. Second floor houses resident rooms, hair salon and library area. Third floor basement area houses activity rooms, card room, movie theater, and staff break room. Facility has multiple patios spread out throughout the facility. Common Areas: Adequate, socially distanced seating is available. Bedrooms Residents: Resident rooms are unfurnished as residents bring their own furnishings. Facility provides a 55 inch smart TV in resident rooms. Bathrooms: All resident bathrooms have a working toilet, wash basin, and shower. Linens & Hygiene Supplies: Residents provide own linens. Facility provides weekly room servicing. Emergency Phone Numbers and Exit Plan: Available for review in the entrance area of the facility. Food Service: Facility has ample supply of food and is currently ordering supplies in anticipation of accepting residents. LPA observed emergency water supply stored in the basement area. Emergency food to be maintained in dry goods storage area. Smoke Detectors: Smoke detectors and sprinklers are serviced by Cal Fire. Carbon monoxide detector is operational. Fire extinguishers are mounted and charged. Kitchen: LPA observed a clean and orderly kitchen with walk in freezer, refrigerator, and dry goods storage area. CONT ON LIC 809C DATED 01/21/2021

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ATRIA NEWPORT BEACH	FACILITY NUMBER: 306005789
	VISIT DATE: 01/21/2021

NARRATIVE

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Temperature logs were posted and available for review. Water Temperature: Tested and recorded between 112.6 and 117.1 degrees F. in tested facility bathrooms. Medications and First-Aid Kit: LPA observed Wellness Department containing locked areas for resident medication, computerized medication administration (emar) and first aid supplies. First aid supplies observed were sufficient including tweezers, scissors, and thermometer. Reading Material, Games, and Equipment: LPA observed activity room and card room as well as an electronic board providing activity information for residents as well as the daily menu. Facility has a library with reading materials for residents. Outside Areas LPA observed multiple patios with ample, socially distanced seating. Fire Clearance: Approved for 195 non-ambulatory residents, of which 10 may be bedridden, on 01/13/2021.

The facility is ready to be licensed. Component III was waived due to Executive Director experience with facility operations.

An exit interview was conducted with Executive Director Rodny via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2021

LIC809 (FAS) - (06/04)

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