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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004582
Report Date: 05/31/2022
Date Signed: 06/01/2022 08:14:34 AM


Document Has Been Signed on 06/01/2022 08:14 AM - It Cannot Be Edited

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 COASTFACILITY NUMBER:
306004582
ADMINISTRATOR:KORNMANN, JENNIFERFACILITY TYPE:
740
ADDRESS:1640 & 1650 MONROVIA AVETELEPHONE:
(949) 629-2100
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY:430CENSUS: 300DATE:
05/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Bob Fiorentino- Executive Director and Selene Lopez- Executive Director TIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit for the purpose of conducting an annual visit. LPA was greeted and granted entry into the facility and explained the reason for the visit to Executive Directors Bob Fiorentino and Selene Lopez.

At 1:30PM, LPA toured the facility with Executive Directors Bob Fiorentino and Selene Lopez Facility has 300 residents in care during today's visit . LPA observed a library, salon, movie theater, card room, activity room, outdoor jacuzzi and indoor pool. LPA observed residents relaxing in the facility or participating in activities. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements. Rooms are single occupancy and double occupancy. Facility screens all visitors to the LPA observed the screening/ sanitizing station in the facility. Facility utilizes an electronic visitor sign in entrance of the building. Facility has emergency evacuation chairs at the top of stairwells. LPA observed an ample supply of emergency food and water. LPA observed multiple outside visitation areas. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed select resident files during the visit and all files are up to date including emergency information.


No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea MendivilTELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022
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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