<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004582
Report Date: 07/24/2025
Date Signed: 07/24/2025 04:21:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
05/05/2021 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20210505135400
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: 305DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Bob FiorentinoTIME COMPLETED:
04:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff failed to seek medical attention in a timely manner
Facility staff speak inappropriately to resident
Staff do not ensure that facility carpets are kept clean
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation via telephone was conducted on May 17, 2021 by LPA Lydia Martinez. During the call, LPA Martinez requested pertinent facility and resident records.

It was alleged facility staff failed to seek medical attention in a timely manner, facility staff speak inappropriately to resident, and staff do not ensure the facility carpets are kept clean. During the investigation, LPA Arias conducted interviews with clients in care and staff. LPA Arias reviewed records obtained.

The investigation determined as follows: Regarding the allegation facility staff failed to seek medical attention in a timely manner, it was reported staff did not seek medical care for Resident 1 (R1). Continued on LIC9099-C dated 07/24/2025
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 22-AS-20210505135400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 COAST
FACILITY NUMBER: 306004582
VISIT DATE: 07/24/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA record review revealed R1 began receiving wound care by Home Health May 17, 2021 on their left leg due to tubi grip used to manage R1's leg swelling. Home Health nurse recommended wound care evaluation by physician in which R1 declined to do so. Wound care by Home Health continued several times per month. R1 was diagnosed with basal cell carcinoma of skin of left lower limb and was admitted for surgery June of 2022. Home Health wound care continued after and wound healed September of 2022. Based on R1's physician's report dated July 8, 2022, R1 is cognitive.

Regarding the allegation, facility staff speak inappropriately to resident, it was reported staff members made fun of R1's weight. LPA interviews with three out of three staff familiar with R1 stated they have never made fun of or observed any other staff make fun of or speak inappropriately to R1. LPA interviews with three out of three residents stated staff is friendly and attentive. Three out of three residents stated they have never been spoken to inappropriately or have observed other residents being spoken to inappropriately by staff.

Regarding the allegation staff do not ensure that facility carpets are kept clean, it was reported R1's carpet in their room had not been cleaned in two years. LPA interviews with 2 out of 3 staff familiar with R1 stated they do not recall seeing dirty carpets in R1's room. LPA observed R1's room who was now being occupied by another resident has wood panel flooring. The remaining 1 out of 3 staff stated the wood panel flooring was present when R1 lived at the facility. LPA interviews with 3 out of 3 residents stated staff always helps them clean their apartments.

Therefore based on client interviews, staff interviews, records observed, and LPA observations, the allegations of facility staff failed to seek medical attention in a timely manner, facility staff speak inappropriately to resident, and staff do not ensure that facility carpets are kept clean are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
05/05/2021 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20210505135400

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: 305DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Bob FiorentinoTIME COMPLETED:
04:35 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not notify resident's authorized representative of a change in resident's condition
Staff do not adhere to the terms in the resident's admission agreement
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation via telephone was conducted on May 17, 2021 by LPA Lydia Martinez. During the call, LPA Martinez requested pertinent facility and resident records.

It was alleged facility staff did not notify resident's authorized representative of a change in resident's condition and staff do not adhere to terms in the resident's admission agreement. During the investigation, LPA Arias conducted interviews with staff. LPA Arias reviewed records obtained.

The investigation determined as follows: Regarding the allegation facility staff did not notify resident's authorized representative of a change in resident's condition, it was reported Resident 1 (R1) had a medical issue that was not reported to R1's family. Continued on LIC9099-C dated 07/24/2025
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20210505135400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 COAST
FACILITY NUMBER: 306004582
VISIT DATE: 07/24/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA record reviewed revealed R1 did not have a responsible party on file. R1 was admitted to the facility on July 16 2013. The admission agreement was signed by R1 as the resident with no responsible party listed. LPA reviewed the latest face sheet for R1 printed on July 24, 2025, there was no responsible party listed. R1's physician's report dated July 8, 2022 showed R1 is cognitive. One out of one staff interviewed stated there was no responsible person or durable power of attorney on file during R1's stay at the facility.

Regarding the allegation staff do not adhere to the terms in the resident's admission agreement, it was reported R1 was being charged additional fees for medication management without informing R1. LPA record reviewed revealed R1's physician's report dated July 8, 2022 did not allow R1 to administer own medications. Assessment conducted by the facility on April 2, 2022 indicated R1 required assistance with medication administration. The assessment was signed by the facility representative and R1. The facility provided R1 with invoice including care fees due on May 1, 2022.

Based on record review and staff interview, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of the report was left with the facility representative.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4