The Vine House Residential Care

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the Pre-Licensing inspection. LPA met with applicant Priscilla Celis. An initial application to operate a Residential Care Facility for the Elderly (RCFE) for 6 non-ambulatory residents of which 1 can be bedridden was submitted to Community Care Licensing (CCL) on June 25, 2025. Facility requested a hospice waiver for 6. Facility phone number 949-503-1464. Structure. The facility is a one story house with 7 bedrooms (bedroom 7 is for staff), 6 bathrooms, living room, kitchen, dining room, laundry room and an attached 2 car garage. The garage is kept locked and used for storage. LPA observed the fire extinguisher in the kitchen is fully charged. LPA observed the See Something, Say Something sign (PUB 475) posted next to the front door. Resident rooms. LPA observed all the resident rooms have the required furnishings and bed linens. LPA observed there is a TV in the living room with sectional sofa that seats 5. LPA observed extra linens stored in the garage. Bathrooms. Facility has 6 bathrooms and all bathrooms are clean and operational. Water Temperature. LPA measured the hot water at 110.8 degrees Fahrenheit in all bathrooms. Emergency Phone Numbers & Exit Plan. LPA observed Personal Rights of Residents posted along with, the Facility's Theft and Loss Policy, Rights of Resident Councils and the Emergency Disaster plan, which contains emergency phone numbers for first responders. The facility sketch showing all emergency exits and exit routes is posted throughout the facility. Appliances. LPA observed the 5 burner stove, microwave oven and refrigerator are all clean and operational. The 5 burner gas stove lights unassisted. The washer and dryer in the garage and are clean and operational. Extra cleaning supplies are kept locked in a cabinet in the garage. Food Service. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The garage is kept locked and used for storage. LPA observed a 3 day emergency supply of food and water in the garage. Toxins and cleaning supplies are kept locked in cabinet in the garage. Resident & Staff Files will be kept secured in the office. Medications are kept locked in the medication closet in the hallway First-Aid Kit & Book are kept locked in medication closet. LPA observed the first aid kit has all the required elements. Reading Material, Games, Equipment & Materials. Reading materials and games are kept in the living room. Fire clearance, the fire clearance was approved by Orange County Fire Authority on July 21, 2025. Backyard No bodies of water observed. There is a table with an umbrella and chairs for residents to sit outside. The exit gates are operational and self closing. No obstacles or hazards observed in the backyard. Smoke Detectors/Carbon monoxide detectors tested operational. Component III: Waived, applicant is the owner/operator of other licensed facilities. No obstacles or hazards observed inside or outside of the facility. Facility has an internet device (Tablet) dedicated for resident use only. LPA observed the front door and the double door in the living room have alarms and sound when opened. No deficiencies observed during the visit. The facility is ready to be licensed. LPA informed the applicant that final approval for licensure will be approved by CAB (Central Applications Bureau) in Sacramento. Applicant stated they understood. Exit interview was conducted and a copy of this report was provided to the applicant.the state’s words, verbatim · CDSS document, Oct 30, 2025

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): Method: Telephone call with CAB COMP II Participants: Celis, Priscilla; Hafez, Fady On 10/17/2025, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 17, 2025