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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004582
Report Date: 01/23/2026
Date Signed: 01/23/2026 11:51:45 AM

Document Has Been Signed on 01/23/2026 11:51 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
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:
01/23/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Bob Fiorentino and Maggie PantaleonTIME VISIT/
INSPECTION COMPLETED:
12:06 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fred Arias conducted an unannounced case management visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by staff and explained the purpose of the visit.

On July 17, 2025, the Orange County Regional Office received an incident report regarding an unwitnessed fall of Resident 1 (R1). The investigation determined the following:

R1 had been admitted to the facility on December 31, 2021, and was a documented fall risk per facility fall risk assessment conducted on December 15, 2021. R1 sustained unwitnessed falls on April 14, 2023; January 4, 2025; January 5, 2025; March 11, 2025; June 19, 2025; July 5, 2025; and July 11, 2025. Physician communications between the facility and R1’s physician and facility progress notes for R1 confirmed R1 sustained a total of seven falls. Although R1’s assessment appraisals was updated at least six times during the falls and identified them as a fall risk, the facility did not document or implement specific fall-prevention interventions or mitigation measures.

On July 11, 2025, at approximately 4:30am, R1 was found on the floor of their apartment following an unwitnessed fall as indicated on the progress note and physician communication for R1 dated the same day. Interviews with two out of three facility staff confirmed that R1 did not activate their pendant to request assistance. All three staff interviewed reported that no routine safety checks were conducted during the night shift for R1 despite R1’s history of falls. Facility records documented that R1 had signed a Night Shift Resident Check Waiver during the admission process on December 15,2021 indicating they did not want to be checked on during the night, despite R1 being identified as a fall risk.
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Fred Arias
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2026
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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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: 01/23/2026
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R1 was transported to Hoag Memorial Hospital for evaluation on July 11,2025, where diagnostic imaging revealed multiple compression fractures, including acute fractures of S1, L4, and T12, as well as chronic compression fractures of L1 and T13. R1 passed away on July 14, 2025, while hospitalized.

Based on the totality of evidence obtained, the Department has concluded that the facility failed to provide adequate care and supervision to a known fall-risk resident by not implementing reasonable safety measures or monitoring practices resulting in R1 sustaining an unwitnessed fall and injury.

The following is being cited per California Code of Regulations, Title 22. A Civil Penalty is pending determination by Community Care Licensing Division as per H&S Code 1569.49(f).

An exit interview was conducted with Senior Executive Director Bob Fiorentino and Assistant Executive Director Maggie Pantaleon and a copy of this report, the LIC 809-D, the LIC 421IM and Appeal Rights were provided to the facility. A copy of this report will be mailed to the licensee to the address on file.
NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: Fred Arias
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/23/2026 11:51 AM - It Cannot Be Edited


Created By: Fred Arias On 01/23/2026 at 11:00 AM
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: 01/23/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2026
Section Cited
CCR
87464(f)(1)

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Basic Services 87464(f)(1)
Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement is not met as evidence by:
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SED stated interventions are put in place based on the fall risk assessment conducted by the Director Health Services. An in-service training will be conducted to ensure intervention measures are implemented for those residents identified as a fall risk. SED to provided proof of training to LPA.
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The Licensee failed to identify fall preventative measures needed to meet R1’s needs resulting in R1 sustaining multiple falls and obtaining a fracture diagnosis on the last fall. This poses an immediate risk to resident’s health and safety.
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Type B
01/30/2026
Section Cited
CCR87463(c)(3)

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Reappraisals 87463(c)(3)
… the licensee shall document all of the following in the resident’s reappraisal: Interventions to be implemented to minimize the risks to the health and safety of the resident...
This requirement is not met as evidenced by:
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SED stated in-service training will be conducted to ensure intervention measures are documented in the resident's file.
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The Licensee failed to document interventions to be implemented to minimize falls after identifying R1 as a fall risk. This poses a potential risk to resident’s health and safety.
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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: 01/23/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2026


LIC809 (FAS) - (06/04)
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