306004582-2-8-2023-22-AS-SSAS-CPH45W-20230228174837

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004582
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:52:43 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
07/18/2022 and conducted by Evaluator Patricia Velazquez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220718141840

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:	09:19 AM
MET WITH:	Bob Fiorentino - Sr. Executive Director		TIME COMPLETED:	12:51 PM

ALLEGATION(S):

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Facility staff are performing services on residents that staff are not trained for
Facility staff caused injury to resident's eye
Facility management are falsifying other employees' training records

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 also reviewed and obtained copies of facility and resident records. Regarding the allegations Facility staff are performing services on residents that staff are not trained for and Facility management are falsifying other employees' training records during the course of the investigation the following was revealed: LPA Velazquez conducted interviews with residents and staff. LPA Velazquez also obtained and reviewed facility, resident, and staff records. The records reviewed included Resident Identification and Emergency Information, Physician's Reports, Vivante Assessments, and Residence and Care Agreement. Additional records reviewed included Relias Training transcripts documenting the training topics and hours completed by each staff member. Four of four individuals

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-20220718141840

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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interviewed stated they only received services performed by licensed individuals and could not corroborate the allegation Facility staff are performing services on residents that staff are not trained for. Fourteen of fourteen individuals interviewed stated they conduct their own training and only perform the work they have been trained for and could not corroborate the allegations Facility staff are performing services on residents that staff are not trained for and Facility management are falsifying other employees' training records. The facility documents each staff training utilizing Relias online training software where each staff utilizes their own log in information to access the training. At 11:25 AM LPA Velazquez along with Health Services Director Deisi Lujan toured the Strands Salon where residents receive services such as haircuts, hair color, manicures and pedicures from licensed cosmetologists and manicurists.

Regarding the allegation: Facility staff caused injury to resident's eye during the course of the investigation the following was revealed: LPA Velazquez conducted interviews with residents and staff. LPA also reviewed facility, resident, and staff records. The records reviewed included Resident Identification and Emergency Information, Physician's Reports, and Vivante Assessments. Additional records reviewed included Relias Training transcripts documenting the training topics and hours completed by each staff member. Fourteen of fourteen individuals interviewed were not aware of any facility staff causing an injury a resident's eye and could not corroborate this allegation.

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: Facility staff are performing services on residents that staff are not trained for, Facility management are falsifying other employees' training record, and Facility staff caused injury to resident's eye are deemed UNSUBSTANTIATED.

An exit interview was conducted with Senior Executive Director Bob Fiorentino and a copy of this report was 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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