306006180-11-21-2022-22-AS-KSGH-CLDSKW-20221121125726

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006180
Report Date: 11/21/2022
Date Signed: 11/21/2022 12:57:37 PM

Document Has Been Signed on 11/21/2022 12:57 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	VIVANTE NEWPORT CENTER		FACILITY NUMBER:	306006180
ADMINISTRATOR:	FOOTE, LIANA		FACILITY TYPE:	740
ADDRESS:	850 SAN CLEMENTE DR		TELEPHONE:	(760) 547-2863
CITY:	NEWPORT BEACH	STATE: CA	ZIP CODE:	92660
CAPACITY:	150	CENSUS: 0	DATE:	11/21/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Liana Foote, Senior Executive Director Cory Alder, owner Josh Sack, Maintenance and Housekeeping Director		TIME COMPLETED:	01:30 PM

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	Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an announced visit to the facility for the purpose of conducting a pre-licensing visit. LPA identified himself and was greeted by Liana Foote, Senior Executive Director. An initial application to operate a Residential Facility for the Elderly was received by Community Care Licensing on 04/07/2022 for a capacity of 150 non-ambulatory residents of which 20 may be bedridden. Facility provides 99 resident rooms over six floors. Floor plans for the rooms include one and two bedroom spaces with six different footprints. The memory care includes both private rooms and shared units with two sets of two bedrooms sharing two bathrooms and a central common lounge area distinct from the unit's dining and activity spaces. LPA observed all infection control measures were in place including proper signage, sanitizing stations, and sign in area/symptom check at the front desk. LPA Saborit-Guasch along with Executive Director Liana Foote, owner Cory Alder and Josh Sack, Maintenance and Housekeeping Director initiated a tour of the facility at 10:00 AM and observed the following: Structure: Facility is a newly constructed concrete building occupying seven levels including a basement. The main floor through which the facility is entered includes a restaurant, kitchen, cafe, private dining area, mail room, common area, resident rooms, library area, administrative offices and a large courtyard with cabanas, outdoor furniture, and activity equipment including shuffleboard and a putting green. The basement includes the gym, swimming pool and spa with secure entrance via a key fob, yoga studio, movie theater, art studio, golf simulator, medical exam room hair salon and bowling alley/arcade. The second floor houses a memory care unit with living units, common and dining area along with a fully enclosed secure patio overlooking the main courtyard as well as resident rooms. The third through the sixth levels only include a variety of resident rooms with either balconies or terraces. Common Areas: Adequate, socially distanced seating is available. CONTINUED ON FORM LIC809-C

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022

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: VIVANTE NEWPORT CENTER	FACILITY NUMBER: 306006180
	VISIT DATE: 11/21/2022

NARRATIVE

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Bedrooms: Resident rooms are generally unfurnished as residents bring their own furnishings, however model furniture can be provided on request should residents desire to do so. Bathrooms: All resident bathrooms have a working toilet, wash basin, shower and/or bathtub and are equipped with non-slip tiles and grab bars. The built-in call system present was activated during the visit and observed to be fully operational. Larger units are equipped with additional bathrooms and/or powder rooms. Linens & Hygiene Supplies: Residents provide own linens with the exception of the memory care unit. Facility provides weekly room servicing and linen laundry. Emergency Phone Numbers and Exit Plan: Available for review in the entrance area of the facility. Food Service: Facility has ample supply of food and is fully supplied in anticipation of accepting residents. LPA observed emergency water supply stored in the basement area. Emergency food to be stored in the same storage area than the emergency water observed. Smoke Detectors: Smoke detectors and sprinklers are observed throughout the physical plant. Carbon monoxide detector is operational. Fire extinguishers are mounted and charged in multiple locations throughout the physical plant. Kitchen: LPA observed a clean and orderly kitchen with walk-in/reach-in freezer, refrigerator, and dry goods storage area. Functioning temperatures for all equipment is observed to be within range. Water Temperature: Tested and recorded between 108 and 114 degrees F. in two test locations per floor. Medications and First-Aid: LPA observed a locked medication room on the first level for assisted living as well as an additional locked room within the memory care units. Med rooms contain locked medication carts, locked refrigeration units for prescribed controlled substances for resident medication and first aid supplies. First aid supplies observed were sufficient including tweezers, scissors, and thermometer. Other first aid kits located throughout the facility. Reading Material, Games, and Equipment: LPA observed ample activity spaces and equipment throughout the facility including outdoor games, a movie theater, bowling alley, arcade, gym and yoga studio. Activity program will be displayed in each units via an internal media channel and is also to be displayed on screens throughout the facility. Facility has a library with reading materials for residents. Outside Areas: LPA observed a large courtyard with ample seating and shaded areas. Fire Clearance: Approved for 150 non-ambulatory residents, of which 20 may be bedridden on 11/18/2022.

The facility is ready to be licensed. Component III was waived due to Executive Director experience with facility operations.

An exit interview was conducted with Senior Executive Director Liana Foote and a copy of this report was provided via and left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2022

LIC809 (FAS) - (06/04)

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