306005585-7-1-2022-22-AS-CDPO-CFWP8M-20220701110546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005585
Report Date: 07/01/2022
Date Signed: 07/01/2022 11:05:51 AM

Document Has Been Signed on 07/01/2022 11:05 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:	VIVIDUS SENIOR LIVING		FACILITY NUMBER:	306005585
ADMINISTRATOR:	SHARIFAN, BAABAK		FACILITY TYPE:	740
ADDRESS:	25131 VIA PORTOLA		TELEPHONE:	(949) 584-0920
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY:	6	CENSUS: 4	DATE:	07/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Administrator - Baabak "Bobbi" Sharifan		TIME COMPLETED:	11:32 AM

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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, two staff were on duty, who contacted facility administrator (AD) Baabak “Bobby” Sharifan about visit. As of 7/1/22, there are no active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary sign posted at the main entrance door. The PUB475 "See Something, Say Something" poster was also observed at the entrance of the facility. LPA observed the Administrator's Certificate for Baabak Sharifan, which expires on August 6, 2023.

LPA De Perio toured the interior and exterior portions of the facility with on duty staff. The facility is a single level structure and is licensed for 6 non-ambulatory residents. Currently, there are a total of 4 residents in care, of which two are under hospice care. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. The restrooms were observed to be in good repair, toilet was operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured at 116.7 degrees Fahrenheit. Hand washing signs were also observed and posted throughout the facility.

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SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: VIVIDUS SENIOR LIVING	FACILITY NUMBER: 306005585
	VISIT DATE: 07/01/2022

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Facility has a supply of two day perishable foods and seven day non-perishable food. Sharp items and knives were locked and inaccessible to the residents in care. Fire extinguisher was charged, mounted and located in the kitchen. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are two gates in the backyard, one which was self-closing and self-latching, and the other gate is not used as an exit. No bodies of water were observed.

LPA observed the emergency disaster and evacuation plan, which is posted at the entrance. Facility had back-up emergency food and water supply, which is located in the garage. LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in the garage. Medications were locked in a cabinet located in the kitchen. Toxins were located in the garage and observed to be inaccessible to residents.

LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with AD Sharifan. LPA De Perio discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued.

LPA De Perio advised AD Sharifan to use the general email address:
CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assign LPA.

LPA De Perio conducted an exit interview with AD Sharifan and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022

LIC809 (FAS) - (06/04)

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