306005789-6-9-2023-22-AS-KSGH-CSMUJU-20230609153806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005789
Report Date: 06/09/2023
Date Signed: 06/09/2023 03:38:43 PM

Document Has Been Signed on 06/09/2023 03:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	ATRIA NEWPORT BEACH		FACILITY NUMBER:	306005789
ADMINISTRATOR:	KEYS, BRIAN		FACILITY TYPE:	740
ADDRESS:	393 HOSPITAL ROAD		TELEPHONE:	(949) 631-3555
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92663
CAPACITY:	195	CENSUS: 86	DATE:	06/09/2023
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Brian Keys, Executive Director Sarah Laloyan, Senior Vice President of Operations		TIME COMPLETED:	03:50 PM

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	On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility for the purpose of conducting a pre-licensing visit for the newly renovated North Building of the facility. LPA was greeted and granted entry by Executive Director Brian Keys. The North Building is a two-level building (with an additional basement level used for parking) situated next to the currently operating South Building. Activities and dining for all Assisted Living residents in the North Building will be held in the South Building's common area. LPA observed all infection control measures were in place including proper signage, sanitizing stations, and sign in area/symptom check at the front desk.Entry into the North Building is also routed through the main lobby where visitors and vendors sign in through an Accushield system allowing facility staff to access real time reporting of the number of visitors present in the facility along with a Care Predict system that is provided to all residents. Work assignments are handled digitally through the system as well in addition to pendant pushes. Facility staff states an average response time of 7.5 minutes for the currently operating building. LPA accompanied by facility staff conducted a tour of the North Building's physical plant and observed the following: Structure: Assisted Living on the second level is based on two typical floor plan including a studio and a one-bedroom apartment. One model unit for each type was observed by LPA to include all necessary items of furnishing. There are a total of 41 apartments on the second level. There are 42 apartments in the Memory Care on the first level, all of which are based on a studio floor plan which includes a private bathroom for every unit. The Memory Care is distributed around three interior modular activities spaces and two exterior spaces and is equipped with a full kitchen. Administrative and wellness offices are located throughout the building as well. CONTINUED ON FORM LIC809-C

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ATRIA NEWPORT BEACH	FACILITY NUMBER: 306005789
	VISIT DATE: 06/09/2023

NARRATIVE

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CONTINUED FROM FORM LIC809

Bedrooms: Resident rooms are generally unfurnished as residents bring their own furnishings. Bathrooms: All resident bathrooms have a working toilet, wash basin, showers and are equipped with non-slip tiles and grab bars. The built-in call system present was activated during the visit and observed to be fully operational.
Food Service: Facility has ample supply of food and is fully supplied in anticipation of accepting residents. Executive director states that a minimum of three days of available menu-based food is present on the present along with 7 days of fresh food. Emergency measures allow for the use of butane to continue providing food in a shelter-in-place scenario. Smoke Detectors: Smoke detectors and sprinklers are observed throughout the physical plant. Carbon monoxide detectors are operational. Fire extinguishers are mounted and charged in multiple locations throughout the physical plant. Kitchen: LPA observed a clean and orderly kitchen with walk-in/reach-in freezer, refrigerator, and dry goods storage area. Functioning temperatures for all equipment is observed to be within range at 33F for the fridge and -8F for the freezer. Medications and First-Aid: LPA observed a locked medication room on the first level for assisted living as well as an additional locked room within the memory care units. The Med room on each level contains a locked rolling file cabinet, a locked medication carts, locked refrigeration units for prescribed controlled substances for resident medication as well as a first-aid kit. Reading Material, Games, and Equipment: LPA observed ample activity spaces and equipment throughout the facility. Activity programs will be displayed in each units via a voice recognition-enabled device and is also to be displayed on screens throughout the facility. A specific activity program is tailored to the Memory Care residents with additional consideration for the various level of dementia acuity displayed by the residents. Outside Areas: LPA observed three enclosed outdoor areas accessible to the memory care unit. A delayed egress exit is observed to be functional with three distinct modes. Fire Clearance: Approved on June 8, 2023 for 195 non-ambulatory residents, of which 10 may be bedridden. A Temporary Certificate of Occupation was delivered to the facility during the visit.

The renovated section of the facility is ready to be included into the license and put into operation.

An exit interview was conducted with Executive Director Brian Keys and a copy of this report was provided via and left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC809 (FAS) - (06/04)

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