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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004582
Report Date: 03/06/2025
Date Signed: 03/06/2025 04:24:32 PM

Document Has Been Signed on 03/06/2025 04:24 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: 430TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
03/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Deisi Lujan-RamirezTIME VISIT/
INSPECTION COMPLETED:
04:37 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fred Arias made an unannounced case management visit to follow-up on an Unusual/ Special Incident Report (SIR) received in our Regional Office on February 20, 2025. LPA was greeted and granted entry by staff. LPA met with Health Services Director (HSD) Deisi Lujan-Ramirez, Executive Director (ED) Selene Lopez and Assistant Executive Director Maggie Pantaleon and explained the purpose of the visit.

LPA obtained the following for review: Appraisal dated 2/1/2025, Service Agreement, and Needs and Services plan for Resident 1 (R1). Facility had already provided a physician's report and additional appraisals dated 1/9/2025 and 2/18/2025 prior to the visit.

HSD explained the details of the incident and reviewed the facility protocols for high fall risk residents. R1 had been placed in hospice care on 1/31/2025, prior to the incident and was reported to our Regional Office by fax.

LPA interviewed three staff members who were familiar with the resident. Staff members stated that resident was checked on approximately every two hours or more often in cases when R1 pressed their pendant. Pendant activation is logged into the facility's internal online systems. During the month of the incident, the resident was checked on at an average of 10-15 times per day. At the time of the incident, the resident's pendant was pressed and a staff member was at their unit in less than 3 minutes.

Based on the observations, record review and interviews made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted and a copy of this report was given to the facility representative.
Alisa OrtizTELEPHONE: (714) 287-4084
Fred AriasTELEPHONE: (714) 703-2840
DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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