Senior Assisted Living at Vintage Reserve

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ivashia Wright conducted an unannounced visit to the facility for a case management visit to follow up on complaint control 18-AS-20260804150117. The LPA was allowed entrance into the facility and met with Pedro Barroso, Administrator. The LPA informed the Administrator of the purpose of the visit. LPA toured the facility and made observations. LPA observed two bedridden residents R1 and R2 residing at the facility. The facility still does not have a bedridden fire clearance at this time and was cited for not having a bedridden fire clearance on 8/4/2026. At deficiency will be cited. A copy of this report, LIC 809D, and LIC 421IM, LIC811 and appeal rights are being provided to Pedro Barroso.the state’s words, verbatim · CDSS document, Sep 28, 2026

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87202(a)2 · Plan of correction due date: Oct 9, 2026

87202 FIRE CLEARANCE (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department... Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate ire clearance approved by the city, county, or city and county fire department...This requirement is not met as evidenced by: (2) of (6) residents are bedridden and there is no bedridden fire clearance.the state’s words, verbatim · CDSS document, Sep 28, 2026

Plan of correction: Administrator will submit the required documents to obtain the proper fire clearance for a bedridden resident. The fire inspection is scheduled for 10/7/26. Will have fire inspectors send STD850 to CCLD by 10/8/26.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ivashia Wright conducted an unannounced annual required visit. Upon entry, LPA was greeted by Pedro Barroso, Administrator and Samira Purmual, informed them of the purpose of the visit. At the time of the visit, there were three (3) staff members and six (6) residents present. Facility Overview: The facility is a single story home with The facility is a one story home with (6) bedrooms and (3) bathrooms a dinning room, an office, living areas, a kitchen, an outdoor area, and a garage. There is no gated pool and there are no firearms on the premises. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked inside a kitchen drawer and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was measured at 106.2F, meeting the department requirements. LPA observed fire extinguishers to be charged and in compliance with the department's requirements. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C.... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate which expires 4/15/2028 and valid CPR certification. Record Review and Resident/Staff Files: LPA reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) resident files were reviewed and contained all required documentation. LPA observed first aid kit to be stored in a hallway closet and inaccessible to residents. Health-Related Services/Incidental Medical Services: All resident medications were securely locked inside a medication cart. LPA reviewed medications for 4 (four) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire/earthquake drill conducted on 7/29/2026. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided to the Administrator Pedro Barroso.the state’s words, verbatim · CDSS document, Sep 10, 2026

Allegation investigated: Facility is not operating within the scope of their license

On August 4, 2026, Licensing Program Analyst (LPA) Ivashia Wright conducted an unannoced visit to the facility to investigate the above allegation. The LPA introduced themselves and explained the purpose for the visit. During the visit, LPA toured the Facility, reviewed and obtained pertinent documentation, and interviewed staff and residents. Regarding the allegation that Facility is not operating within the scope of their license, it was reported that six (6) of six (6) residents are bedridden. After reviewing the facility's fire clearance it was observed that the facility never did receive a fire clearance for bedridden residents. Cont on LIC 9099c Substantiated Information obtained from interview with staff stated majority of the residents are bedridden. Information obtained from review of R1's 602's indicated the resident is bedridden and has been admitted to the facility since 3/9/2026. Information obtained from review of R2's 602 indicated the resident is bedridden and has been admitted to the facility since 11/9/2023. Therefore, the two residents #1 and #2, identified during todays visit as being bedridden will need to be relocated to a facility that has a bedridden fire clearance. Based on witness interviews, staff interviews, facility records, and LPA observations, the allegation that Facility is not operating within the scope of their license is deemed substantiated. A substantiated finding means that the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. A copy of this report, LIC9099C, LIC 9099D, LIC 421FC, and appeal rights are being provided to Pedro Barroso.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 18-AS-20260804150117

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)2 · Plan of correction due date: Aug 5, 2026

87202 FIRE CLEARANCE (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department... Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department...This requirement is not met as evidenced by: (2) of (6) residents are bedridden and there is no bedridden fire clearance.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: The adiministrator will provide a eviction notice according to regualtions for R1 and R2 to CCLD by 5pm on 8/5/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 81068.2(a) · Plan of correction due date: Aug 12, 2026

81068.2 Needs and Services Plan: (a) The licensee shall complete a Needs and Services Plan for each client as required in Sections 81068.2, 82068.2, 82568.2, 84068.2, or 85068.2. This requirement is not met as evidenced by: Resident's records review revealed zero (0) out of the six (6) residents have a Needs and Service Plan.This poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: The administrator will provide copies of Needs and Services Plan for each resident to CCLD by 8/12/2026 5pm.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with, Staff, Samira Purmul who were informed of the purpose of the visit. At the time of the visit there was (3) staff and (5) residents present. The facility is a one story home with (6) bedrooms and (3) bathrooms with attached garage. No pools or firearms are being kept at the facility. Infection Control: The LPA observed hygiene supplies, PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. Physical Plant: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were observed in good condition. The outdoor area was observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff schedule showing adequate staff coverage. Required postings were found in the facility. The listed administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed (3) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (2) resident files were reviewed, and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident medication were locked in a medication cart. LPA reviewed medications for clients and found all medication listed on MARS and accounted for. All medications had the required labeling and doctor's orders. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The last conducted fire drill was conducted on 8/17/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the and first aid kit with all required items. No deficiencies were cited at the time of the visit. An exit interview was conducted with Licensees,Pedro Barroso over the phone, and Samira Purmul in person.the state’s words, verbatim · CDSS document, Sep 9, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.