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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005789
Report Date: 01/31/2025
Date Signed: 01/31/2025 03:40:00 PM

Substantiated


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
01/22/2025 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250122114459
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: 157DATE:
01/31/2025
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Brian Keys-Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not prevent resident from exiting facility alone.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Hanna Gough conduct an unannounced initial visit and to deliver findings on the above allegation received on January 22, 2025. LPAs were greeted and granted entry into the facility and met with Executive Director (ED) Brian Keys. LPAs explained the reason for the visit.

This Department has investigated the complaint alleging that staff did not prevent resident from exiting facility alone. Resident 1 (R1) was admitted to the facility on November 22, 2024. Documents reviewed included the Physician Report (LIC602) dated July 05, 2024, for R1. Per Physician report R1’s diagnosis is Alzheimer’s dementia. Regarding the allegation that staff did not prevent resident from exiting facility alone, the following was revealed: During the investigation LPA reviewed documents including the Physician Report for R1. Per Physician Report for R1 under Mental Condition it states that R1 has wandering behavior. LPA reviewed documents including the Unusual Incident/Injury Report (UIIR) dated December 10, 2024, for R1.
CONTINUED ON LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
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 5
Control Number 22-AS-20250122114459
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: 01/31/2025
NARRATIVE
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Per UIIR Report on December 10, 2024, R1 exited the building, resident was found at a local elementary school and resident was returned to the building. During the investigation LPA reviewed documents including the Preplacement Appraisal Information dated November 20, 2024, for R1. Per Preplacement Appraisal Information R1 is not mentally and physically able to follow signals and instructions for evacuation. During the course of the interviews with Staff, Staff 1 (S1) reported that one of the team members left the door open and stated that R1 exited behind the staff member. Per S1, staff noticed that R1 was missing approximately 20 minutes after. S1 reported that the local Police Department was called and stated that R1 was found within 45 minutes.

An immediately $500 Civil Penalty was issued today.

Based on observations and the interviews which were conducted, the preponderance of evidence standard has been met, therefore the following allegation: staff did not prevent resident from exiting facility alone is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.



An exit interview was conducted with ED Keys and a copy of this report along with the Appeal Rights were provided at the time of this visit.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250122114459
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2025
Section Cited
CCR
87464(f)(1)
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Basic Services: Basic services shall at a minimum include: (1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: Based on interviews and records reviewed R1 exited the Memory Care through a
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Licensee to submit a Plan on Action on how facility will prevent Residents from Eloping from Memory Care. Licensee to provide an in-service training on Elopement prevention. Licensee to submit Plan of Corection (POC) by POC due date.
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delayed egress door, left the facility unassisted and was found at a local Elementary School. This poses an immediately health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
01/22/2025 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250122114459

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: 157DATE:
01/31/2025
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Brian Keys-Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Resident was issued an unlawful eviction
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Hanna Gough conduct an unannounced initial visit and to deliver findings on the above allegation received on January 22, 2025. LPAs were greeted and granted entry into the facility and met with Executive Director (ED) Brian Keys. LPAs explained the reason for the visit.

This Department has investigated the complaint alleging that Resident was issued an unlawful eviction. Resident 1 (R1) was admitted to the facility on November 22, 2024. Regarding the allegation that Resident was issued an unlawful eviction, the following was revealed: During the initial visit on January 31, 2025, LPA observed that R1 was residing in the Memory Care. During the course of the investigation LPA reviewed the Orange County Regional Office Eviction Log and observed that as of January 31, 2025, no 30-Day Eviction has been received for R1. LPA reviewed documents including the Atria Newport Beach Resident Functional Needs Assessment dated January 14, 2025, for R1.
CONTINUED ON LIC9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250122114459
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: 01/31/2025
NARRATIVE
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Per Atria Newport Beach Resident Functional Needs Assessment R1 requires status checks every two hours for up to 14 hours per day. During the course of the interviews with Staff, Staff 1 (S1) reported that R1 was never issued an Eviction and stated that R1 needs a 1:1 caregiver for their safety.

Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.



LPAs conducted an exit interview with ED Keys, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5