306004582-2-8-2023-22-AS-SSAS-CPH4A8-20230228175531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004582
Report Date: 02/08/2023
Date Signed: 02/08/2023 04:00:39 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
08/16/2022 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220816144317

FACILITY NAME:	VIVANTE ON THE COAST		FACILITY NUMBER:	306004582
ADMINISTRATOR:	ROBERT FIORENTINO II		FACILITY TYPE:	740
ADDRESS:	1640 & 1650 MONROVIA AVE		TELEPHONE:	(949) 629-2100
CITY:	COSTA MESA	STATE: CA	ZIP CODE:	92627
CAPACITY:	430	CENSUS: 320	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Bob Fiorentino - Sr. Executive Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff does not provide adequate care and supervision to a resident
Staff mistreated a resident while in care
Staff did not properly maintain a resident's room while in care
Staff are not meeting a resident's needs while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced subsequent complaint visit to deliver the findings of the investigation into the above allegations. LPA Velazquez was allowed entry into the facility and met with Senior Executive Director (SED) Bob Fiorentino and explained the purpose of the visit.

On today's visit LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also reviewed and requested facility, resident and private duty aide records. Regarding the allegations: Staff does not provide adequate care and supervision to a resident, Staff mistreated a resident while in care, Staff did not properly maintain a resident's room while in care, and Staff are not meeting a resident's needs while in care, during the course of the investigation the following was revealed. LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also reviewed and requested facility, resident, staff and private duty aide records. The records reviewed included resident Identification and Emergency Information, Physician's Reports, Vivante Assessments, and Admission Agreement. Additional records reviewed included Relias Training

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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-20220816144317

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: VIVANTE ON THE COAST	FACILITY NUMBER: 306004582
	VISIT DATE: 02/08/2023

NARRATIVE

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transcripts documenting the training topics and hours completed by each staff member, Private Duty Aide records including Home Care Organization Affiliation, Criminal Record Clearance, Health Screenings with TB test results, and Vivante on the Coast Private Duty Aide Personnel Policies. Twelve of twelve individuals interviewed could not corroborate any of the 4 allegations. Six of six individuals interviewed felt they were well-cared for with the facility providing adequate care and supervision, and felt they were treated with respect and dignity. Resident (R) #1 had a specific Private Duty Aide who no longer works with R1. The investigation revealed the allegations may have involved the Private Duty Aide that previously worked with R1. R1's family is currently working with a different Private Duty Aide Homecare Agency in providing R1 the additional assistance they require. LPA Velazquez observed R1's apartment was clean and well maintained as were the other 3 apartments LPA toured. LPA also observed R1 to be clean and well-groomed while in the company of 2 Private Duty Aides.

Based on the observations made, interviews which were conducted and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Staff does not provide adequate care and supervision to a resident, Staff mistreated a resident while in care, Staff did not properly maintain a resident's room while in care, and Staff are not meeting a resident's needs while in care are all deemed UNSUBSTANTIATED.

An exit interview was conducted with Senior Executive Director Bob Fiorentino and a copy of this report along with the LIC 811 were provided at the time of this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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