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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004582
Report Date: 10/15/2025
Date Signed: 10/15/2025 03:48:55 PM

Document Has Been Signed on 10/15/2025 03:48 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VIVANTE ON THE COASTFACILITY NUMBER:
306004582
ADMINISTRATOR/
DIRECTOR:		ROBERT FIORENTINO IIFACILITY TYPE:
740
ADDRESS:1640 & 1650 MONROVIA AVETELEPHONE:
(949) 629-2100
CITY:COSTA MESASTATE: CAZIP CODE:
92627
CAPACITY: 430CENSUS: DATE:
10/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:57 AM
MET WITH:Bob FiorentinoTIME VISIT/
INSPECTION COMPLETED:
04:03 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Fred Arias and Kimberly Lyman arrived unannounced for the purpose of conducting the Required 1 Year Annual Evaluation. LPAs were greeted and granted entry by staff and explained the reason for the visit. LPAs met with Senior Executive Director (SED) Bob Fiorentino, Executive Director Selene Lopez and Assistant Executive Director Maggie Pantaleon.

There are two buildings, north and south, with separate entries. The South Building, 1640, is comprised of an Assisted Living (AL) and Memory Care (MC). The North Building, 1650, is comprised of an AL. All common areas in both buildings were inspected which includes but is not limited to: Fitness Centers, pool/jacuzzi, dinning area, emergency food and water storage, rec room, and activity rooms. LPAs inspected ten resident apartments which had all required elements. The residents' personal bathrooms were checked. Toilets, water faucets, and grab bars were secure. Showers were free of mold/mildew. The hot water temperature for the ten bathrooms measured within range as per regulation between 108.3 and 116.2 degrees Fahrenheit. LPAs inspected the kitchens. Facility maintains ample supply of perishables and non-perishable food. At 11:05am, LPA observed a gallon of bleach stored under the sink unlocked in the prep kitchen in the memory care area. The fire extinguishers were mounted and fully charged. The smoke detector testing passed on September 8, 2025 and September 10, 2025 per the fire alarm system inspection report conducted by VFS Fire & Security Services. LPAs toured the outside grounds. LPAs observed the courtyards which had sufficient shading and seating. The walkways were clear of hazards. The swimming pool gates were secure. LPAs observed sufficient emergency food and water in both buildings. LPAs observed residents participating in activities such as exercising, swimming, and story time.

Continued on LIC809-C dated 10/15/2025
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Fred Arias
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VIVANTE ON THE COAST
FACILITY NUMBER: 306004582
VISIT DATE: 10/15/2025
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Emergency evacuation drills are conducted quarterly with the last drill conducted on September 18, 2025. LPAs observed the 'See Something, Say Something' (PUB475) poster in the correct size. Facility maintains a current liability insurance.

LPAs conducted an audit of ten residents' files and ten personnel files. No discrepancies noted. Medications were audited. No discrepancies noted.

Based on the observations made during today's visit, a deficiency is being cited. An exit interview was conducted and a copy of this report was provided along with appeal rights.
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Fred Arias
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/15/2025 03:48 PM - It Cannot Be Edited


Created By: Fred Arias On 10/15/2025 at 03:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: VIVANTE ON THE COAST
FACILITY NUMBER: 306004582

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, a one gallon bottle of bleach was stored under the kitchen prep sink in memory care unlocked and accesible by residents which poses an immediate health and safety risk to persons in care.
POC Due Date: 10/16/2025
Plan of Correction
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AD stated in-service training will be conducted for culinatry and care staff in memory care. Beach was removed from the memory care area. Facility to email proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:
Fred Arias
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2025


LIC809 (FAS) - (06/04)
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