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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005789
Report Date: 11/24/2021
Date Signed: 11/24/2021 10:59:46 AM

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 BEACHFACILITY NUMBER:
306005789
ADMINISTRATOR:RODNY, BENJAMINFACILITY TYPE:
740
ADDRESS:393 HOSPITAL ROADTELEPHONE:
(949) 631-3555
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92663
CAPACITY:195CENSUS: 59DATE:
11/24/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Dori RedmanTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced health and safety case management visit in conjunction with complaint visit 22-AS-20211122170311. LPA Lyman met with Digital Innovation Director Dori Redman and discussed the reason for visit.

During the visit, LPA toured the facility. LPA observed residents relaxing or participating in activities. LPA spoke with Resident 1 (R1) who was visiting with family. LPA spoke with R2 in the dining room. Both residents appeared happy and well taken care of. LPA toured R1's room and observed a ring camera in the resident's room. Facility appears clean and sanitary and are adhering to Covid-19 guidelines.

LPA consulted with Director Redman regarding guidelines pertaining to cameras in resident rooms.

No health or safety violations noted during today's visit.

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: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
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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