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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004640
Report Date: 10/13/2026
Date Signed: 10/13/2026 03:05:02 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
09/15/2026 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20260915111905
FACILITY NAME:NEWPORT MESA SENIOR LIVINGFACILITY NUMBER:
306004640
ADMINISTRATOR:MELVIN GALLOWAYFACILITY TYPE:
740
ADDRESS:2891 BEAR STTELEPHONE:
(949) 629-1020
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:40CENSUS: 20DATE:
10/13/2026
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Judy TorresTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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staff unable to provide timely medical attention and medications timely to residents
Facility missing Emergency Information forms for residents
Lack of staffing
Resident was left in soiled underwear
Facility doesn't have supplies readily availble to staff
Resident over medicated
Residents had unexplained bruises
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 unable to provide timely medical attention and medications timely to residents and lack of staffing, the investigation revealed the following: LPA reviewed the staffing schedule which is as follows; Three caregivers/ med tech on 1st and second shift and two caregivers/ med tech on NOC shift with Memory Care Director filling in as needed. Staff indicate there was a one time instance when the Administrator filled in as a med tech at night. Five out of five staff state facility has been struggling to fill positions but management fills in as needed to ensure resident needs are being met. LPA reviewed select medication administration records and did not observe any discrepencies. 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)
Page: 1 of 2
Control Number 22-AS-20260915111905
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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Regarding the allegation that facility missing emergency Information forms for residents: LPA observed emergency information packets for residents in a binder at the facility. Four out of five staff state knowledge of the emergency packets and their contents and deny issues with the packets. Four out of five staff state having the ability to call 911 as needed without permission. LPA observed the first aid kits are available to all staff.

Regarding the allegation that resident was left in soiled underwear: Four out of five staff deny an incident with the resident left soiled as well as denying knowledge of who the resident is.

Regarding the allegation that facility doesn't have supplies readily available to staff: LPA toured the supply closets on two different occasions. LPA observed facility has the minimum supply of briefs, wipes, gloves and cleaning supplies. Four out of five staff deny a lack of supplies.

Regarding the allegation that resident over medicated: LPA reviewed select medication administration records and observed no discrepancies. LPA unable to ascertain which resident was over medicated and all staff deny knowledge of a resident being over medicated.

Regarding the allegation that residents had unexplained bruises: LPA reviewed progress notes for Residents 1-3. All residents are on hospice care and being observed frequently by hospice. Resident 1 has agitation and a scratch on leg but no noted bruising in facility notes. R2 has aggression and a wound but no noted bruises. R3 has a noted rash but no bruising.

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)
Page: 2 of 2