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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004582
Report Date: 08/22/2025
Date Signed: 08/29/2025 10:56:44 AM

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
04/09/2021 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20210409100807
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: DATE:
08/22/2025
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Selene LopezTIME COMPLETED:
10:47 AM
ALLEGATION(S):
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Facility did not follow safe food handling practices.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged facility did not follow safe food handling practices. During the investigation, LPA conducted interviews with staff, reviewed records obtained and made observations.

The investigation determined as follows: regarding the allegation facility did not follow safe food handling practices, it was reported resident 1 (R1) ate contaminated food. LPA record review revealed R1’s son reported R1 had vomited during on outing on April 7, 2021. Upon his return the same day to the facility, R1 reported they were fine and no longer nauseous. On April 8, 2021, R1 had diarrhea and the facility sent R1 to the hospital for evaluation.
Continued on LIC9099-C dated 08/22/2025
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
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 2
Control Number 22-AS-20210409100807
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: 08/22/2025
NARRATIVE
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R1 returned to the facility on April 10, 2021 from the hospital with a diagnosis of C-diff. Resident was prescribed antibiotics and was placed on isolation precautions.

LPA interviews with three out of three staff stated the kitchens in both the north and south buildings have never been closed due to contamination. One out of three staff stated they recall an instance from April 11, 2021 to April 13, 2021 when in-person dining services were suspended due to an outbreak of Rotavirus. The facility followed isolation and sanitation protocols and offered meals delivered to residents in their rooms prepared in the facility kitchens.

On a previous visit on July 29, 2025 regarding this complaint, LPA reviewed valid food handler certificates for 104 current kitchen staff. LPA toured the facility and observed kitchen staff following sanitation protocols including wearing gloves while prepping food, using separate types of cutting boards for meats and produce, and washing of kitchen utensils and tools in both the north building kitchen and south building kitchen.

A third party Dietician report for the facility dated June 17, 2021 did not indicate any major concerns for the facility kitchens.

A third party Dietician report for the facility dated July 17, 2025 did not indicate any major concerns for the facility kitchens and stated "Overall, the kitchen was in compliance with temperature requirements, safe, and organized." for each kitchen observed.

Therefore based on staff interviews, records observed, and LPA observations, the allegation facility did not follow safe food handling practices is therefore deemed unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

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

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2