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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005789
Report Date: 06/16/2023
Date Signed: 06/16/2023 09:58:22 AM


Document Has Been Signed on 06/16/2023 09:58 AM - It Cannot Be Edited

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:KEYS, BRIANFACILITY TYPE:
740
ADDRESS:393 HOSPITAL ROADTELEPHONE:
(949) 631-3555
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92663
CAPACITY:195CENSUS: DATE:
06/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Kyle Coleman
Brian Keys		TIME COMPLETED:
10:15 AM
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On this day, Licensing Program Analyst (LPA) Claudia Gutierrez made a unannounced visit to the facility for the purpose of conducting a case management visit regarding operations of the newly renovated North Building of the facility. LPA met with Memory Care Director (MCD) Kyle Coleman and toured the premises. MCD confirmed that residents had begun moving-in yesterday and the building currently has a total of three residents. All three residents are in memory care, which is located on the first floor of the building. Residents were observed to be in their bedroom and engaging in a walking activity. Residents have meals delivered from the main building and activities are being provided directly one one one with each resident. LPA observed activity calendar posted and visible in the activity room. The second story will be used for assisted living and currently has no residents.

Executive Director Brian Keys arrived at 9:30 a.m. No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia GutierrezTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2023
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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