306006180-10-24-2023-22-AS-SSAS-CX5U2S-20231031151225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006180
Report Date: 10/24/2023
Date Signed: 10/24/2023 04:04:44 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
07/07/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230707142754

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: 77	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mirella Manjarrez, Assistant Executive Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff failed to meet resident's medical needs

Resident sustained multiple falls due to neglect

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the two allegations listed above. LPA was greeted and granted entry by Assistant Executive Director Mirella Manjarrez after stating the reason for the visit.

An initial complaint investigation visit was conducted on July 14, 2023. LPA accompanied by administrator toured the Memory Care unit. LPA requested, obtained and reviewed resident records for two residents. Additional staff and witness interviews were conducted. Medical records were obtained from Hoag Health through a subpoena and subsequently reviewed.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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

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
07/07/2023 and conducted by Evaluator Kevin Saborit-Guasch

COMPLAINT CONTROL NUMBER: 22-AS-20230707142754

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: 77	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Mirella Manjarrez, Assistant Executive Director		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
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8
9

Residents sustained bed sores due to neglect

INVESTIGATION FINDINGS:

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2
3
4
5
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7
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9
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11
12
13

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above. LPA was greeted and granted entry by Assistant Executive Director Mirella Manjarrez after stating the reason for the visit.

An initial complaint investigation visit was conducted on July 14, 2023. LPA accompanied by administrator toured the Memory Care unit. LPA requested, obtained and reviewed resident records for two residents. Additional staff and witness interviews were conducted. Medical records were obtained from Hoag Health through a subpoena and subsequently reviewed.

CONTINUED ON FORM LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20230707142754

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 NEWPORT CENTER	FACILITY NUMBER: 306006180
	VISIT DATE: 10/24/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099-A

Regarding the allegation that Residents sustained bed sores due to neglect, the following has been concluded: Based on a review of medical records which include four separate physical examinations performed by multiple attending physicians on June 7, June 16, June 17 and June 18, 2023, there was no noted presence of pressure injuries that would have been sustained by R1 during their admission at the facility. As a result, the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20230707142754

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 NEWPORT CENTER	FACILITY NUMBER: 306006180
	VISIT DATE: 10/24/2023

NARRATIVE

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CONTINUED FROM FORM LIC9099

Regarding the allegation that Staff failed to meet resident's medical needs, the following has been concluded: Based on interviews and records reviewed, resident R1's condition started declining due to the onset of pneumonia. Hospital records reviewed did not point out any new or worsening health condition which could be attributable to inadequate care. Each instance of concern about the resident's health was addressed by a referral to the paramedics and transport to the hospital. A failure to meet R1's medical needs can therefore not be evidenced. The allegation is therefore found to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did occur.

Regarding the allegation that Resident sustained multiple falls due to neglect, the following has been concluded: A review of available records evidenced two separate unwitnessed falls occurring on June 6 and June 17, 2023. In both instances, paramedics were activated for evaluation and R1 was transported to the Emergency Department for evaluation and wound care as is required by Title 22 regulations. Facility additionally reported the hospital visits to the Department. However the evidence gathered cannot establish a direct relation between the falls and inadequate care and supervision by facility staff. Shortly after the second fall, the resident was diagnosed with sepsis related by a respiratory infection which may also have contributed to the occurrence of the fall. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did occur.

An exit interview was conducted and a copy of the present report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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