Vine Residence

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit. LPA was met by Vanessa Godina Chinchilla, Care giver and explained the purpose of the visit. Shortly after, administrator Lorraine Lopez arrived to assist LPA. The facility is licensed to serve age range 60 and over, (6) ambulatory of which (5) may be non ambulatory and (1) may be bedridden. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The required cleaning and disinfection activities are performed. Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are adhering to infection control requirements. Physical Plant & Environment Safety: This facility is a single story home consists of (6) resident bedrooms, (3) bathrooms, (2) living rooms, family room, kitchen, dining area, attached garage and backyard. Resident bedrooms were toured and have sufficient storage space and lighting. Knives, cleaning solutions and disinfectants are locked. The smoke detectors and carbon monoxide detectors are operable. Laundry washing machine and drying machine is in the garage. There are (3) fireplaces adequately screened and covered with a plexiglass, (2) in the living room and one in the family room. All the appliances in the kitchen are working properly. The sharp knives and utensils are stored and locked in the kitchen drawer. Cleaning supplies and chemicals are stored and inaccessible to residents. There are cameras located in the common areas. No security window bars installed. Facility has working telephone service. Water temperature readings are within the required 105 - 120 degrees Fahrenheit. Indoor and outdoor passageways were kept free of any obstruction. Backyard was inspected and has (2) sitting areas with outdoor furniture. There is a swimming pool that is locked and gated with a fence. Operational Requirements: The Infection Control Plan has been added to the Plan. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and $3,000,000.00 in the total annual aggregate is valid, expires on 08/01/2026. There are (2) fire extinguishers that are fully charged, last serviced on 04/17/2026. The outdoor activity area in the backyard provides a shaded area and furnished for outdoor use.*****Refer to LIC 809C for the continuation of this report.***** Due to time constraints, LPA will return at a later date for a continuation visit. LPA will complete the remaining domains: Staffing, Personal Records-Training, Resident Rights-Information, Planned Activities, Food Service, Incidental M & D, Resident Records-Incident Reports, Disaster Preparedness, Residents with SHN. Exit Interview conducted and a copy of the report was provided to the Administrator, Lorraine Lopez.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted the unannounced required annual inspection. LPA arrived unannounced and met with Caregiver Sandra Portillo Alvarde. Administrator, Lorraine Lopez, arrived shortly thereafter to assist. The purpose for the visit was explained. The facility is licensed for residents ages 60 and over. 6 Ambulatory, of which 5 may be non-ambulatory and 1 may be bedridden. Hospice Waiver for 6 residents. Currently, there are two (2) residents are on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Facility has an updated infection control plan in place. The facility staff and residents continue to practice the hand washing and disinfecting the facility each shift. The facility has sufficient PPE supplies. 2. Operational Requirement: The facility has approved for 5 non-ambulatory and 1 may be bedridden currently there's only one resident is bedridden which is within the fire clearance requirement. LPA observed current Liability insurance in place. The facility has a dementia care plan to accept or retain residents with dementia. 3. Physical plant and Environmental Safety: The facility is a single-story house and located around the neighborhood area. The facility include living room, staff break room with a divider, six residents’ bedrooms, three residents’ bathrooms, kitchen, dining area, family room and attached garage. Laundry washing machine and drying machine is in the garage. 3. Physical plant and Environmental Safety: Each resident has one bed, one chair, one drawer and required furniture and beddings and sufficient lighting and closet space. All three resident's bathrooms are clean, sanitary and in a good working condition. The hot water temperature in all three bathrooms were tested between 113.7- and 114.1 degrees F which is within Regulations. The bathroom has the required non-skid mat and grab bar in the shower. There are two fireplaces with one in the living room and one in the family room is adequately screened and secure. All the appliances in the kitchen are working properly. The sharp knives and utensils are stored and locked in the kitchen drawer. All the dish soap are stored and locked under the sink. All cleaning supplies and chemicals are stored and locked in the cabinet located in the garage. All the extra personal hygiene products are stored and locked in the garage cabinet. The facility has a telephone on the premises. The carbon monoxide detector are working well in the facility. The facility has a pool in the backyard and it's locked and gated with a fence. The passageway, walkway and patio are free of obstruction. Fire Extinguisher located in the kitchen is fully charged and was last inspected on 04/21/2025. 4. Staffing: Facility has a sufficient staffing to provide care and supervision to the residents. Each facility staff has an updated First aid and CPR certificate. The NOC shift staff has an updated facility emergency planned procedure training. 5. Personal Records-Training: All staff are over 18 years old, fingerprint cleared and associated with the facility. LPA reviewed the admin and three (3) staff files which includes: personnel record, Health Screening, TB test result, Employee Rights, ongoing staff training and medication management training. The facility administrator is Lorraine Lopez and certificate expire 11/13/2025 and she has the required training hours as a qualified administrator. 6. Resident's Right: The RCFE complaint poster and personal right poster posted on the wall in the living room. The facility has internet service and provide at least one internet access device such as computer or tablet and equipped with video conferencing and residents can have meetings with their family or their physician if needed. 7. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 8. Food Service: The facility has sufficient food supply including minimum 2 days perishable and 7 days non-perishable. The facility kitchen is clean and well-kept and in a operable condition. The food are properly stored in the refrigerator to avoid cross contamination. No resident required a modified diet that's prescribed by the doctor. Facility staff will chop the food for resident to prevent choking. 9. Incidental Medical and Dental: The facility will arrange residents' medical and dental appointment if needed. All the resident's medication are centrally stored and locked in the cabinet in the hallway. LPA inspected all six residents’ medication and they all seemed accurate and updated and they all have 30 days’ supply of medication. 10. Resident Record-Incident Reports: All the resident file in the facility has all the required documents including emergency identification and information form, signed admission agreement, updated medical assessment, Ambulatory Status, TB test results, Resident Appraisal, Personal Rights, Centrally Stored Medication Destruction Record, Safeguards for Personal Property/Valuables, functional capability assessment, pre-appraisal and appraisal / needs and service plan, and medication list in the file. 11. Disaster Preparedness: The facility has an updated emergency Disaster plan in place. The facility has at least two appropriate alternative shelter location. The last disaster drill was conducted on 03/19/2025. The emergency exit plan and telephone number posted on the wall in the living room. 12. Resident with Special Health Needs: Currently the facility has two residents on hospice and one bedridden and it's within the requirement and fire clearance. All staff does have the required training for the hospice and dementia residents. The hospice residents has the updated information in their hospice record along with the resident's file. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit Interview conducted and a copy of the report was provided to the Administrator, Lorraine Lopez.the state’s words, verbatim · CDSS document, May 20, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Wong conducted the required annual inspection. LPA arrived unannounced and met with Caregiver Aura McKenzie. Administrator, Lorraine Lopez, arrived shortly thereafter to assist. The purpose for the visit was explained. The facility is licensed for residents ages 60 and over. 6 Ambulatory, of which 5 may be non-ambulatory and 1 may be bedridden. Hospice Waiver for 6 residents. Currently, there are three (3) residents are on hospice. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: Facility has an updated infection control plan in place. The facility staff and residents continue to practice the hand washing and disinfecting the facility each shift. The facility has sufficient PPE supplies. All the staff in the facility has the updated Health Screening and TB test result in file. 2. Operational Requirement: The facility has approved for 5 non ambulatory and 1 may be bedridden currently there's only one resident is bed ridden which is within the fire clearance requirement. LPA observed the updated Liability insurance and has the sufficient amount for liability insurance covering injury to residents and guests. The facility has a dementia care plan to accept or retain residents with dementia. 3. Physical plant and Environmental Safety: The facility is a single story house and located around the neighborhood area. The facility include: living room, staff break room with a divider, six residents bedrooms, three residents bathrooms, kitchen, dining area, family room and attached garage. Each resident bedroom has one bed, one chair, one drawer and required furniture and beddings and sufficient lighting and closet space. All three resident's bathrooms are clean, sanitary and in a good working condition. The hot water temperature in all three bathrooms were tested between 114.9 and 120 degrees F. The bathroom has the required non-skid mat and grab bar in the shower. The fireplace in the living room is adequately screened. All the appliances in the kitchen are working properly. The sharp knives and utensils are stored and locked in the kitchen drawer. All the dish soap are stored and locked under the sink. All cleaning supplies and chemicals are stored and locked in the cabinet located in the garage. All the extra personal hygiene products are stored and locked in the garage cabinet. The facility has a telephone on the premises. The carbon monoxide detector are working well in the facility. The facility has a pool in the backyard and it's locked and gated with a fence. The passageway, walkway and patio are free of obstruction. 4. Staffing: Facility has a sufficient staffing to provide care and supervision to the residents. Each facility staff has an updated First aid and CPR certificate. The NOC shift staff has an updated facility emergency planned procedure training. 5. Personal Records-Training: All staff are over 18 years old, fingerprint cleared and associated with the facility. All staff has the updated training hours. The facility administrator is Loraine Lopez and certificate expire 11/13/2025 and she has the required training hours as a qualified administrator. 6. Resident's Right: The RCFE complaint poster and personal right poster posted on the wall in the living room. The facility has internet service and provide at least one internet access device such as computer or tablet and equipped with video conferencing and residents can have meetings with their family or their physician if needed. 7. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 8. Food Service: The facility has sufficient food supply including minium 2 days perishable and 7 days non-perishable. The facility kitchen is clean and well kept and in a operable condition. The food are properly stored in the refrigerator to avoid cross contamination. No resident required a modified diet that's prescribed by the doctor. Facility staff will chop the food for resident to prevent choking. 9. Incidental Medical and Dental: The facility will arrange residents' medical and dental appointment if needed. All the resident's medication are centrally stored and locked in the cabinet in the hallway. LPA inspected all six residents medication and they all seemed accurate and updated and they all have 30 days supply of medication. 10. Resident Record-Incident Report: All the resident file in the facility has all the required documents including: face sheet, signed admission agreement, updated medical assessment, functional capability assessment, pre-appraisal and needs and service plan and ambulatory status and medication list in the file. 11. Disaster preparedness: The facility has an updated emergency Disaster plan in place. The facility has at least two appropriate alternative shelter location. The last disaster drill was conducted on 4/17/24. The emergency exit plan and telephone number posted on the wall in the living room. 12. Resident with special health needs: Currently the facility has three residents on hospice and one bedridden and it's within the requirement and fire clearance. All staff does have the required training for the hospice and dementia residents. The hospice residents has the updated information in their hospice record along with the resident's file. No deficiencies were observed Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 16, 2024