306004582-7-1-2020-22-AS-RMAZ-BR4QJX-20200701121327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004582
Report Date: 07/01/2020
Date Signed: 07/01/2020 12:13:34 PM

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:	VIVANTE ON THE COAST		FACILITY NUMBER:	306004582
ADMINISTRATOR:	KORNMANN, JENNIFER		FACILITY TYPE:	740
ADDRESS:	1640 MONROVIA AVE		TELEPHONE:	(949) 629-2100
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	299	CENSUS: 0	DATE:	07/01/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Bob Fiorentino, Executive Director		TIME COMPLETED:	11:30 AM

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	Licensing Program Analyst (LPA) Ruth Martinez contacted the facility via FaceTime application, using iPhone technology, to commence a case management inspection due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the announced video call and spoke with Bob Fiorentino, Executive Director. Fire Department shows clearance granted on June 30, 2020 to change in capacity for new building construction #1650 to reflect capacity 131 / Asst. Living units 111. During today’s visit LPA along with Executive Director took a tour of the physical plant of building #1650. LPA found physical plant is consistent with the submitted facility sketch/floor plan. Structure: The facility is a four-story building with 111 apartment style units consisting of studio, 1 bedroom or 2 bedroom apartment. The resident’s apartments are spacious and will easily accommodate the resident’s furnishings. Facility has a bistro on the first floor, dining is located in the first floor, mail room for residents, large kitchen, entertainment center, art studio, fitness center, yoga/dance studio and a laundry room. Signal system: Central air/heating system installed with a central panel to control entire building common areas. Each apartment has its own panel to control air/heating individually per apartment. Bedrooms Residents: Each apartment is equipped with a full kitchen with cook top, microwave, oven, dishwasher, refrigerator/freezer, bathroom and a laundry unit with washer and dryer. There are apartments that have a patio or balcony for resident’s enjoyment. CONTINUED on LIC809-C

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIVANTE ON THE COAST	FACILITY NUMBER: 306004582
	VISIT DATE: 07/01/2020

NARRATIVE

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Bathrooms:
All bathrooms have a working toilet, wash basin, walk in shower.

Linens & Hygiene Supplies:
Adequate supply of linens, cleaning supplies, hygiene items are store in housekeeping storage in each floor of building.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed in mail room. Menus posted and available. Menus prepared one week prior and listed for food serve for one week.

Food Service:
Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen.

Smoke Detectors:
Smoke detectors and carbon monoxide alert systems are hardwired through out the building and monitored and tested by an outside vendor.

Appliances:
Each apartment has a gas four-burner stove, single oven, 1 refrigerator/freezer, dish washer, microwave, washer, and dryer are clean and noted to be operational.

Toxins:
All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents are stored and locked in housekeeping storage in each floor of building.

Water Temperature:
Tested and recorded the water temperature measures 106 to 111 Fahrenheit degrees in all restrooms from first floor to fourth floor apartments.
CONTINUED on LIC809-C

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIVANTE ON THE COAST	FACILITY NUMBER: 306004582
	VISIT DATE: 07/01/2020

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Medications, First-Aid Kit & Book:
Medication stored in medication room in first floor inaccessible to residents. First aid kits are stored and located in medication room, kitchen, front desk and all common areas of building.

Resident & Staff Files:
Records will be kept locked in storage cabinet located in business directors office.

Pool/Jacuzzi & Pets:
No bodies of water in facility #1650.

Fire Extinguisher:
Mounted in wall in all common areas of the building dated April 11, 2020.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, and other recreational materials for the resident’s use, commensurate with the plan of operation.

Fire clearance:
Was approved on June 30, 2020.

Applicant was reminded that it is required to notify LPA, within 5 business days of admitting the first resident. This notification may be done by phone, email, mail or fax.

Based on today's inspection living accommodations and grounds have been found adequate for the requested change in capacity; all items reviewed during today's visit are in compliance.

Change of capacity request to be forwarded to management for final review and approval. Approval notification to licensee will be made by CCL and new license will be mailed to licensee.

Exit interview was conducted and a copy of this report was emailed to facility representative and facility representative agrees to submit a signed copy by email.

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2020

LIC809 (FAS) - (06/04)

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