Vintage Residential 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Maria Rojas. Facility Administrator, Cynthia Grape arrived at the facility during the visit. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Additionally, the facility is approved for a hospice waiver for two (2). During today’s inspection there were six (6) residents in care and LPA observed (4) residents watching T.V. and one resident was reading and one resident was observed using her computer and iPhone. None of the residents are on hospice services.. LPA and Caregiver Rojas toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Residents' bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink in common bathroom read at 102F and a private resident bathroom read at 103.6F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and kept inaccessible to residents in care. [Continued on LIC 809-C] (Continue from LIC809) No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. A pool exists on the premises and LPA observed the pool to be secured with a surrounding fence required per regulation. Gates were noted to be locked. Additionally, a small water fountain fixture is present at the front yard of the facility. Per Caregiver Rojas, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced June 2026. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed two (2) staffs and two (2) residents, and interviews did not reveal any licensing or regulatory concerns. LPA provided technical assistance pertaining to reporting requirements, address in a separate Case Management report. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator, Grape to whom a copy of this report was provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 1, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced case management visit at the facility. LPA was greeted at the front entrance by Caregiver Rojas, identified herself, and was granted entry into the facility. Administrator Cynthia Grape arrived during the visit. During the visit, LPA discussed Title 22 reporting requirements with the Administrator, specifically the requirement to report unusual incidents involving residents, including changes in condition requiring medical evaluation or treatment, and other incidents required under California Code of Regulations, Title 22, Section 87211, Reporting Requirements. LPA also discussed the facility's responsibility under Section 87466, Observation of the Resident, to monitor residents for changes in physical, mental, emotional, and social functioning and to ensure appropriate medical evaluation and follow-up when warranted. During the discussion, the Administrator informed LPA that the facility had not been reporting incidents involving residents who experienced changes in condition requiring medical evaluation, including residents exhibiting behaviors that were later determined to be associated with urinary tract infections (UTIs). The Administrator stated that the facility did not believe these incidents were required to be reported because they were not considered medical emergencies. LPA explained that Section 87211 requires the reporting of unusual incidents affecting the health, safety, or welfare of residents, including significant changes in condition requiring medical evaluation, regardless of whether the incident constitutes a medical emergency. (continue at LIC809C) (continue from LIC809) LPA further explained that timely reporting enables Community Care Licensing (CCL) to monitor resident health and safety trends, evaluate the effectiveness of facility interventions, and determine whether additional regulatory action or follow-up is necessary. Following further discussion, the Administrator acknowledged LPA's explanation of the reporting requirements and indicated an understanding of the importance of reporting unusual incidents and changes in condition to CCL in accordance with Title 22 regulations. Technical assistance was provided regarding California Code of Regulations, Title 22, Sections 87211, Reporting Requirements, and 87466, Observation of the Resident. Copies of the applicable regulations were provided to the Administrator. No violations were issued during the visit. An exit interview was conducted with Administrator Cynthia Grape. A copy of this report and Licensee Rights (LIC 9058) were provided.the state’s words, verbatim · CDSS document, Jul 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Caregiver Maria Rojas. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Additionally, the facility is approved for two (2) hospice waivers. During today’s inspection there were five (5) residents in care and LPA observed residents eating a meal together and engage in activities. Executive Director Cynthia Grape arrived later during the visit. LPA and Caregiver Rojas toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were all compliant: Bathroom sink in common bathroom read at 105F and a private resident bathroom read at 105.6F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. Knives were locked and kept inaccessible to residents in care. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. A pool exists on the premises and LPA observed the pool to be secured with a surrounding fence required per regulation. Gates were noted to be locked. Additionally, a small water fountain fixture is present at the front yard of the facility. Per Caregiver Rojas, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced June 2025. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed one (1) staff and three (3) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Executive Director Grape to whom a copy of this report was provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 29, 2025

Allegation investigated: Administrator threatened to evict resident Administrator is not allowing essential medical visitors Administrator is interfering with residents' medical care

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by Caregiver, Maria Rojas, to whom she identified herself and discussed the purpose of the visit. During the visit LPA spoke with Administrator, Cynthia Grape and explained the reason for the visit. The Department investigated the above-listed complaint allegations. The investigation consisted of a tour of the facility, multiple interviews with staff, residents, and outside sources, and a detailed review of relevant records. On March 22, 2021, Community Care Licensing (CCL) received a complaint alleging that the Administrator threatened to evict resident (R1). [a LIC 811 Confidential Names List was provided to staff to identify the resident] It was specifically alleged that on or about March 10, 2021, the Administrator informed R1 that they could not continue to live at the facility if they received medical care from an outside agency. (Continue at LIC9099C) Unsubstantiated (continue from LIC9099) Interviews with R1 indicated that they were never served with an eviction notice. Multiple interviews with staff and outside sources consistently indicated they never witnessed the Administrator or any other staff member threatening R1 or any other resident they would get evicted if they received medical services from an outside agency. Detail review of resident records disclosed other residents living in the facility were receiving medical services from outside agencies. A detailed review of R1’s medical records indicated that R1 began receiving medical services from an outside agency on October 14, 2021. Multiple interviews with staff and outside sources disclosed that R1 continued to live at the facility under the care and supervision of an outside agency with coordinated care provided by facility staff. During multiple interviews with staff and outside sources, it was consistently stated that R1 voluntarily moved out on November 18, 2021, to another licensed facility of their choice. Multiple interviews with R1, staff and outside sources confirmed that the Administrator coordinated efforts with the outside agency to facilitate the relocation to a facility with the ability to provide higher level of care to meet R1’s needs. On December 12, 2024, CCL confirmed R1 was still living at the other licensed facility. The investigation did not yield supporting evidence to corroborate that the Administrator threatened to evict R1. It was also alleged that the Administrator did not allow essential medical visitors. It was specifically alleged that the Administrator did not allow the outside agency to meet with R1 at the facility to discuss medical services. During multiple interviews with staff and outside sources, it was consistently indicated that the Administrator requested the outside agency personnel to coordinate appointments with facility staff before coming to the facility. This would avoid visitors showing up in large numbers at the same time which could potentially interfere with staff's ability to provide care and supervision to other residents in care. Staff also stated that they wanted to be present during medical care meetings to ensure they could coordinate services with the outside agency to meet R1's needs. During interviews, staff and residents consistently stated that they had never witnessed the Administrator or any other staff not allowing essential medical visitors for R1 or any other resident in the facility. In addition, a detailed review of the facility visitor logs for January, February, and March 2021 disclosed more than 160 visitors registered. The facility census was (4) residents this would equate to an average of 40 visitors per resident in 90 days. Based on the interviews and records reviews there was insufficient corroborating evidence found to support this allegation. (continue at LIC9099C) (continue from LIC9099C) Lastly, it was alleged that the Administrator interfered with R1’s medical care. It was specifically alleged that the Administrator insisted on being present during medical care meetings between R1 and the outside agency personnel. As stated in the prior allegation, during interviews, staff indicated they insisted on being present during medical care meetings because they wanted to be informed to ensure R1’s service care needs were being coordinated among both agencies. In addition, during interviews, R1 stated they wanted the Administrator to be present during care meetings to ensure their service care needs were being met Based on the results of the investigation, which consisted of observations, interviews with staff, and outside sources, and a review of pertinent resident and facility records, there was insufficient evidence to support the allegations. Therefore, these allegations are deemed unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violation occurred. An exit interview was conducted with Caregiver, Maria Rojas, to whom a copy of this report, Confidential Names List (LIC 811), and Licensee Appeal Rights (9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 13, 2024 · control 08-AS-20210322143050

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Annual visit. LPA met with Administrator, Cynthia Grape, and we discussed the purpose of the visit. Grape is the certified administrator for the facility, and her Administrator's Certificate expires on 11/3/2024. The facility file was reviewed before the visit. According to the facility’s license, the facility is approved for six (6) non-ambulatory residents. Currently, the hospice waiver is approved for two (2) residents. During today’s visit, there were a total of six (6) residents in care, all of whom were non-ambulatory. There were three (3) staff at the facility, all staff had current criminal record clearance and current CPR certificates were on file. The facility was assessed by touring it inside and out. LPA inspected for compliance with safety, maintenance, and operational requirements. LPA interviewed staff, as well as general conversation with residents in care. All residents were observed to be clean, groomed, and free from bad odors. During the visit, five (5) residents were observed to be eating by themselves in the dining area. One resident required assistance with feeding. Administrator Grape indicated that there are no firearms stored on the premises. There were two (2) areas available for dining. Residents eat meals together three (3) meals per day most of the time. There were at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. (continue at LIC809) (continue from LIC809) There is a facility pool, and LPA toured the area. Access to the pool is restricted with fencing, locked accessible only by staff. The door was secured during LPA's visit. Exit doors equipped with alarms. The hot water temperature was measured during the visit (114 degrees F). The appliances in the resident rooms were in working order. Each room observed was clean, sanitary, and in good operating condition. Bathrooms inspected had grab bars installed, by the toilets and shower areas. Cleaning supplies for the housekeeping staff were secured away from residents. Medications were labeled, as required and stored in locked areas. Keys to the medication cabinets were kept and controlled by appropriate staff with responsibility for medication management. LPA interviewed staff and reviewed multiple staff and resident records/files. LPA interviews did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in locked areas. Facility staff conducted an emergency drill in February 2024. LPA discussed with staff the requirement to keep records for all emergency drills conducted, including the date, time, and staff/residents who participated as required. The facility updated its disaster and emergency preparedness plan in 2024 and facility liability insurance was current with an expiration date of January 2025. No violations were observed during the visit. During the visit, an exit interview was conducted with the Administrator, Grape, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, May 22, 2024