306004640-10-13-2026-22-AS-AORZ-DYWT9K-20261016143204

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004640
Report Date: 10/13/2026
Date Signed: 10/13/2026 03:03:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
09/09/2026 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20260909100358

FACILITY NAME:	NEWPORT MESA SENIOR LIVING		FACILITY NUMBER:	306004640
ADMINISTRATOR:	MELVIN GALLOWAY		FACILITY TYPE:	740
ADDRESS:	2891 BEAR ST		TELEPHONE:	(949) 629-1020
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92626
CAPACITY:	40	CENSUS: 20	DATE:	10/13/2026
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Judy Torres		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff are not giving medications as prescribed
Staff are not seeking timely medical treatment
Staff are not able to communicate with emergency personnel
Facility is not maintained clean and sanitary

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

During the course of the investigation, LPA toured the facility and interviewed staff. Regarding the allegation that staff are not giving medications as prescribed, the investigation revealed the following: On 08/03/2026, Resident 1 (R1) was seen at Hoag Hospital for a urinary tract infection and prescribed cefpodoxime 200 mg. Review of R1's medication administration record showed that R1 received the medication from 08/04-08/09/2026. Staff indicated family requested to have back up antibiotics on hand for urinary tract infections but physician did not provide those orders.
Regarding the allegation that staff are not seeking timely medical treatment: R1 was sent out to the hospital on 09/07/2026 after being found on the ground. Facility notes as well as CONTINUED ON LIC 9099C DATED 10/13/2026

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20260909100358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NEWPORT MESA SENIOR LIVING	FACILITY NUMBER: 306004640
	VISIT DATE: 10/13/2026

NARRATIVE

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incident report indicated staff called 911 when the resident was sent out. Family was notified and there were no injuries present on resident.

Regarding the allegation that staff are not able to communicate with emergency personnel: LPA interviewed five staff who were effectively able to communicate. Staff indicate everyone is able to communicate to 911 if called. Staff confirm permission to call 911 when it is warranted.

Regarding the allegation that facility is not maintained clean and sanitary: LPA toured the facility and R1's room on two different occasions. Both times facility is observed to be clean, safe and sanitary.

Based on record review and interviews conducted, LPA is unable to corroborate the allegations.
Therefore, the allegations are deemed UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred.
An exit interview was conducted and a copy of this report this report was left at the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2026

LIC9099 (FAS) - (06/04)

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