The Vintage Farmhouse

Type of visit: Case Management - Other

On 09/04/25, Licensing Program Analyst (LPA) Kimberly Viarella arrived to conduct an inspection proceeding the official closure of the facility. LPA identified herself, stated the purpose of the visit and met with the Designated Facility Administrator, Kimberly Tiller. The Administrator called Community Care Licensing (CCL) and notified them of the closure on 07/28/25. The Administrator stated they were closing because the landlord had chosen to sell the property. The 3 residents in care were relocated prior to CCL being notified. LPA toured the facility with the Licensee. LPA observed that there were no residents at the facility. LPA received final closure roster of clients from Licensee on 07/31/25. LPA collected the copy of the License that the Administrator had posted during today's visit, and advised Licensee that the facility will be closed in the system as of 09/04/25. A copy of this report was left with Licensee. Link to survey for Facility Closure provided to Licensee. www.surveymonkey.com/r/facilityclosure Exit interview.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Required - 1 Year

On 12/5/2024, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the facility unannounced to conduct an annual required inspection. LPA initially met with a staff on duty (S1) and stated the purpose of this visit. The administrator, Kimberly Tiller was notified and arrived later. Present during today's visit were 5 residents in care with 1 staff on duty (S1) LPA evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected include but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. The facility is a one-story home located in a residential neighborhood. Facility is fire cleared to retain/admit 6 non-ambulatory residents with approved hospice waiver for 4 residents. Facility has 5 resident bedrooms, all of which were approved for non-ambulatory. 4 of the bedrooms were single bed and master bedroom is shared. 1 bedroom was designated to staff room. Facility has 3 bathrooms for resident use. 1 of which is located in the master bedroom. LPA observed the facility to be free of odor, clean and in good repair at this time. LPA observed 3 of 5 resident bedrooms to be equipped with the required furniture and sufficient lighting throughout the facility. LPA inspected 2 of 3 bathrooms and were observed to be equipped with slip resistant flooring and overall in good repair at this time. Hot water temperature in 1 resident bathroom was measured at 120 degrees F. Room temperature was observed at 73 degrees F. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers were observed and were last inspected on 9/19/24. Smoke and carbon monoxide detectors were tested and observed to be operable during this visit. LPA observed centrally stored medications, toxins, and sharp objects were kept locked and inaccessible to residents in care. Fireplace was observed to be screened and non-operational at this time. LPA observed activity supplies for residents. {1 of 2} Outdoor areas were observed to be clean and clear of hazards at this time. No bodies of water was observed at this time. Fence and gates were observed to be in good repair at this time. LPA observed outdoor furniture and outdoor activity area was observed to be spacious for resident use. Review of 3 sample resident files (R1, R2, R3) which include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. No hospice residents at this time. Technical advisory was provided to administrator to obtain PRN Authorization Letter signed by residents' physician. Medication review of 3 sample residents which includes review of resident medication, centrally stored medication record, and physician orders for over-the-counter medications. Facility do not maintain medication administration record (MAR) at this time. No issues were noted at this time. Review of 4 sample staff files which include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator Certificate is current. 3 of 4 staff did not have current 1st aid/CPR certificate. Facility conducts monthly disaster drill and last drill was on 12/1/24. Facility has infection control plan and emergency disaster plan. LPA reviewed first aid kit and was found to be complete. Administrator provided a copy of current Liability Insurance Certificate, LIC500 and LIC308 to LPA. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during today's visit. Exit interview was conducted and a copy of the report was provided upon exit. {2 of 2}the state’s words, verbatim · CDSS document, Dec 5, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Collateral

On 8/30/2024 Licensing Program Analysts (LPAs) Graham Gunby and Cheyenne Ratajczak arrived unannounced at the facility to conduct a collateral visit. LPAs met with Administrator Kimberly Tiller and explained the purpose of the visit. LPAs conducted a visit to this facility today to follow up on R1 who was relocated to this facility on 8/29/2024. R1 was relocated due to a Temporary Suspension Order issued at another licensed facility by the Department. LPAs spoke to R1 who indicated that they are doing well. Additionally, they stated that they are nervous for the new environment, but optimistic since their family is close. No deficiencies are cited during today's visit. Exit interview was conducted and copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Aug 30, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 11/17/23 at 12:30pm. Administrator Certificate expires 4/24/24. Licensing fees are current. LPA met with Diana Albu, Caregiver who contacted the Administrator Kimberly Tiller regarding the purpose of todays visit. Administrator arrived within 15 minutes to assist with todays visit. The facility is licensed for a capacity of 6 non-ambulatory residents in rooms 1-5 and the master bedroom of which 4 may receive hospice care services. There are 0 residents receiving hospice care services during this visit. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed and interviewed a random amount of residents. LPA observed 2-day perishables and 7-day non-perishables. The facility has an Infection Control Plan on file. The temperature inside the facility was observed to be at 77 *F which is within the required range of 68-85*F. The hot water temperature was measured at 118.3*F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 1 staff and 2 resident files and conducted interviews during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308), Control of Property, Administrator Certificate-Updated Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Nov 17, 2023