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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004582
Report Date: 07/29/2025
Date Signed: 07/29/2025 03:18:05 PM

Document Has Been Signed on 07/29/2025 03:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VIVANTE ON THE COASTFACILITY NUMBER:
306004582
ADMINISTRATOR/
DIRECTOR:		ROBERT FIORENTINO IIFACILITY TYPE:
740
ADDRESS:1640 & 1650 MONROVIA AVETELEPHONE:
(949) 629-2100
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 430CENSUS: 331DATE:
07/29/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Maggie Pantaleon- Assistant Executive Director
Danica Coronel- Shores Program Director (Memory Care)
Selene Lopez- North Executive Director
Bob Fiorentino- Executive Director		TIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced Case-Management-Deficiencies visit and met with Executive Director Bob Fiorentino by telephone and in person with North Executive Director Selene Lopez, Assistant Executive Director Maggie Pantaleon, and Shores Program Director Danica Coronel and explained the reason for the visit.

During the investigation of Complaint Control #: 22-AS-20250130140500, the following deficiencies were discovered: The investigation revealed that when facility care staff assignments from November 19, 2024, were requested, Staff #1 (S1) indicated that caregiver assignments have been archived while Staff #2 (S2) indicated that caregiver assignments are only kept for 90 days which is in violation of the Title 22 regulation requiring records to demonstrate adequate staff coverage necessary for facility operations be retained. Based on the review of records, the facility was not updating documented behaviors of Resident #1 (R1) from September 2024 to October 2024 on the service plan dated/effective on December 15, 2024. The service plan documented the incidents occurring in November 2024. The incidents never addressed the increase and frequency of R1’s aggressive behaviors and if additional staff was needed to meet the behavioral needs of R1. Additionally, the facility did not self-report any incidents involving R1 documented in the facility’s Progress Notes dating back from August 13, 2024 which is in violation of the Reporting Requirements which also includes any incidents which threatens the welfare, safety, or health of any resident. Therefore, deficiencies are being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC809Ds. An exit interview was conducted with Executive Director Bob Fiorentino by telephone and in person with North Executive Director Selene Lopez, Assistant Executive Director Maggie Pantaleon, and Shores Program Director Danica Coronel, and a copy of this report wiht the appeal rights were provided at the end of the visit.
Lourdes Montoya
Jessica Cho
DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/29/2025 03:18 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Jessica Cho On 07/29/2025 at 02:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIVANTE ON THE COAST
FACILITY NUMBER: 306004582

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
07/30/2025
Section Cited

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87412 Personnel Records (e) In all cases, personnel records shall demonstrate adequate staff coverage necessary for facility operation by documenting the hours actually worked. (h) All personnel records shall be retained for at least three (3) years following termination of employment. This requirement was not met as evidenced by:
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Based on interviews and record review, staff assignments for 11/19/24 were not provided during the investigation as they were archived and only kept for 90 days.
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Under Appeal
Type A
07/30/2025
Section Cited

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Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate.
This requirement was not met as evidenced by:
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Based on interviews and record review, the service plan for R1 was incomplete as it did not document behaviors from September 2024 to October 2024 and include how the facility will address the increase or frequency of R1’s aggressive behaviors
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Assistant Executive Director, Shores Program Director, North Executive Director, and Executive Director agreed to submit proof of R1's appraisal, conduct an inservice with staff, and submit an Acknowledgment of Understanding of the said deficiency by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Jessica Cho
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/29/2025 03:18 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Jessica Cho On 07/29/2025 at 02:33 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIVANTE ON THE COAST
FACILITY NUMBER: 306004582

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
07/30/2025
Section Cited

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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below…
This requirement was not met as evidenced by:
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Based on record review, facility did not furnish written incident reports to the Department involving R1 since 8/13/24 with the exception of the incident on 11/19/24.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Jessica Cho
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2025


LIC809 (FAS) - (06/04)
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