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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005789
Report Date: 07/22/2024
Date Signed: 07/22/2024 01:55:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
07/18/2024 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240718151623
FACILITY NAME:ATRIA NEWPORT BEACHFACILITY NUMBER:
306005789
ADMINISTRATOR:KEYS, BRIANFACILITY TYPE:
740
ADDRESS:393 HOSPITAL ROADTELEPHONE:
(949) 631-3555
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92663
CAPACITY:195CENSUS: 135DATE:
07/22/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brian KeysTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Facility did not ensure resident's safety
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made unannounced visit regarding the complaint allegation above. LPA Haley was granted entry and explained the reason for the visit upon entry. During the visit LPA Haley was lead on a tour of the Assisted Living portion of the facility and made observations, conducted interviews with facility staff, one resident, and one witness during the complaint investigation.

Regarding the allegation: Facility did not ensure resident's safety.

Regarding the safety of Resident 1 (R1), 6 of 7 individuals interviewed were unable to corroborate the complaint allegation as reported. During the investigation it was discovered R1 was served two glasses of wine at the bar before being assessed and eventually sent out to the hospital. According to Staff 1 (S1), R1 is a very talkative person and was nowhere near that baseline before being sent to the hospital. Staff 4 (S4) stated before 911 was called, R1 was yelling at other residents and talking nonsense so S4 went to assess R1 and eventually called 911.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
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-AS-20240718151623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 BEACH
FACILITY NUMBER: 306005789
VISIT DATE: 07/22/2024
NARRATIVE
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When 911 was called they decided to transport R1 for intoxication. R1 returned to the facility a few hours later and had a private care companion for the remainder of the night.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegation is deemed Unsubstantiated.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2