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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006180
Report Date: 11/13/2024
Date Signed: 11/13/2024 05:15:55 PM

Document Has Been Signed on 11/13/2024 05:15 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 NEWPORT CENTERFACILITY NUMBER:
306006180
ADMINISTRATOR/
DIRECTOR:
FOOTE, LIANAFACILITY TYPE:
740
ADDRESS:850 SAN CLEMENTE DRTELEPHONE:
(760) 547-2863
CITY:NEWPORT BEACHSTATE: CAZIP CODE:
92660
CAPACITY: 150CENSUS: 144DATE:
11/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:31 AM
MET WITH:Bob Fiorentino, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On this day, Licensing Program Analysts (LPA) Kevin Saborit-Guasch and Nancy Guillen made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were greeted and granted entry after introducing themselves and the purpose of the visit to front desk staff. Executive Director Bob Fiorentino was notified of the visit via telephone and arrived later to assist with the visit.

LPAs requested and reviewed the facility's resident census, staff roster, Emergency and Disaster Plan, Infection Control Plan, staff records including training records from Relias. A sample of fifteen staff records and fourteen resident records were reviewed during the visit. There are 144 residents admitted at the time of the visit, six of which are receiving hospice care. 26 of these 144 residents are admitted to the Memory Care unit. Resident and staff records were confirmed to include all necessary components per Title 22 regulations. One concierge staff member was however found to be missing a background check altogether. Type A citation and civil penalty issued during the visit.

The facility is a seven-story building (including the lower level or basement) organized around a central coutryard. LPAs accompanied by administrator and facility maintenance staff conducted a tour of the interior and exterior of the physical plant. A total of thirteen units out of a total of 91 were visited and reviewed throughout the facility. Rooms were observed to be equipped with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floors and tiling. Hot water was measured in a total of fifteen locations at faucets delivering hot water for grooming purposes. Water was systematically observed to be within the acceptable temperature range.

CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: VIVANTE NEWPORT CENTER
FACILITY NUMBER: 306006180
VISIT DATE: 11/13/2024
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CONTINUED FROM FORM LIC809
LPAs and staff additionally toured the facility kitchen. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Emergency food and water supply observed in the basement food storage.

Medications, cleaning supplies, and sharp items were inaccessible to residents in care in the memory care unit. LPA reviewed the physician orders and contents of one of the facility's medication cart. Sprinkler system and fire safety systems were inspected on November 28, 2023 and November 12, 2024. For the exterior portion, facility has a central courtyard with multiple patio and ample quantity of outdoor furniture and activity materials. The routes of egress were free of tripping hazards and the exit gates were self-latching and functional. Proof of liability insurance for the period of 09/01/2022 until 09/01/2023 was provided however due to a recent change of insurance provider, licensee was unable to provide current documentation during the visit and will provide the required documentation at its earliest convenience.

One type A deficiency is cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
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Document Has Been Signed on 11/13/2024 05:15 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 11/13/2024 at 04:55 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 NEWPORT CENTER

FACILITY NUMBER: 306006180

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 11/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.17(b)(1)(B)
Per HSC 1569.17(b)(1)(B): "In addition to the applicant, the provisions of this section shall apply to criminal record clearances and exemptions for the following persons: (D) Any staff person, volunteer, or employee who has contact with the clients."

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records reviewed, the licensee did not comply with the section cited above as one concierge staff member was observed to be missing their background clearance after turning 18 in late October 2024. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/14/2024
Plan of Correction
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Licensee will ensure staff member receives the appropriate background clearance and association prior to their next scheduled shift at the facility. Documentation of clearance to be provided to LPA.
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.
SUPERVISOR'S NAME:Sheila Santos
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 11/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/13/2024


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