Vintage Faire Residential

Type of visit: Case Management - Deficiencies

Unannounced case management visit made out to this facility on 09/14/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 46 residents. This case management visit was conducted in conjunction with the complaint visit that was conducted and completed on this same day. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal Rights were printed and copy was left with the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Sep 14, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1) · Plan of correction due date: Sep 15, 2026

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This facility was found to be deficient as evidenced by the lack of reporting of an incident involved with a resident's finances being misused by a facilty staff person which posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.the state’s words, verbatim · CDSS document, Sep 14, 2026

Plan of correction: The facility designated Administrator stated that all special/unusual incidents involving facility residents and facility staff should always be reported within the appropriate time frames to remain in compliance at all times. A statement of correction, along with updated staff training for no less than (1) hour in duration, on the topic of Reporting Requirements will be completed and submitted into CCL by the due date for review by this LPA.

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 09/14/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 46 residents. Tour of this facility was conducted. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 08/26/2026. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 08/26/2026: All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. 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 or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. (1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training course work may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. All window screens shall be clean and maintained in good repair. The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Plan of Correction clearance letters were printed and copies were provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Sep 14, 2026

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 08/26/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility Business Office Manager Joyce Prasad who was briefly interviewed at this time. The facility designated Administrator, Jose Ventura, was contacted and unable to be present during today's annual visit. Current census was 46 residents. It was learned that there were (7) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (10) residents at any given time. It was learned that there were (10) residents diagnosed with dementia at this time. This facility does have an approved program to be able to accept and retain residents diagnosed with dementia at any given time. Tour of the facility was conducted. A tour of the facility kitchen area was conducted. Food storage units, refrigerator and freezer, were toured. It was observed that there was a sufficient supply of 2-day perishable food quantities available on site to meet the requirements at this time. Pantry area was toured. It was observed that there was a sufficient supply of 7-day nonperishable food quantities available on site to meet the requirements at this time. A sample review was conducted for the facility resident bedrooms at this time. It was observed that furniture and furnishings were observed to be functional and maintained in compliance at this time. A sample review was conducted for the facility resident restrooms at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Grab bars and non skid surfaces were observed to be present and maintained in compliance at this time. Living areas, dining areas, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Laundry rooms, located throughout several wings of this facility on the first floor, were toured. They were reviewed to make sure that they were observed to be locked and made inaccessible to the residents in care. Rooms designated as supply rooms, storage rooms, and equipment rooms were reviewed to make sure that they were locked and made inaccessible to the residents at this time. Medication room was toured at this time. Policies and procedures in regards to the handling, dispensing, and documentation of the resident medications were discussed at this time. This facility utilized medication carts when it was time to dispense the medications to the residents. First aid kit, located in the medication room, was observed to contain all of the required components at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company, Johnson Controls, on 12/03/2025 and found to be in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the perimeter fence, side gates, and all other exits was conducted at this time. A review of (6) facility resident files was conducted and noted on the following LIC 858. A review of (6) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested by this LPA to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Civil penalty in the amount of $500 was assessed on the following LIC 421 Appeal rights were printed and a copy was given to the facility designated representative at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 26, 2026

Allegation investigated: Staff do not ensure the facility is clean and sanitary Facility is malodorous

Unannounced complaint visit made out to this facility on 07/21/2026 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Kulich who were met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time. Current census was 48 residents. The purpose of this complaint visit was to inform this facility, and it's representative, that a complaint had been filed with the above allegations at this time. A brief tour of the facility was conducted. A review of the resident bedrooms was conducted. A review of the dining room and other areas designated for resident use was conducted. A brief tour of the hallway and facility corridors was conducted. It was observed that new flooring was recently put into place in the hallways and common areas of this facility. It was observed that a facility notice was posted on the bulletin board next to the facility activities calendar informing all facility residents and staff that renovations were going to take place during the week ending 07/06/2026. These renovations involved the removal of the old carpet that lined the hallways and common areas that were going to be replaced Unsubstantiated with new vinyl flooring. It was learned that the posting of the construction project for the flooring was put up on 06/30/2026 with a commencement date of 07/06/2026. Based on a review of the facility rooms and common areas it was observed by LPAs that the resident rooms were maintained in compliance to meet the needs of the residents at this time. In addition, it was observed that the common areas were maintained in compliance to meet the needs of the residents at this time as well. It was observed that there weren't any strong odors that would suggest that housekeeping and proper maintenance was not being upheld at this time. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 21, 2026 · control 27-AS-20260717110513

Allegation investigated: Resident sustained injury due to staff neglect

Unannounced complaint visit made out to this facility on 07/01/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was interviewed at this time. Current census was 48 residents. The purpose of this visit was to deliver the findings from this investigation to this facility, and its representative, at this time. Based on a review of the forms and documents gathered during the course of this investigation, it was learned that a specific incident took place on 05/26/2026 involving resident R1. It was learned that a facility staff person observed that R1 exited another resident's room with a bump on R1's right forearm. It was learned that staff approached R1 and inquired about the bruise to which R1 stated that they were unaware about the origin of the bruise and could not recall how it came about. It was learned that documentation noted that the responsible party for R1 was notified on that same day about the bruising and a follow up medical visit was scheduled for R1 to undergo an X-ray to rule out any further injuries or possible fracture. Unsubstantiated Based on a review of the forms and documents gathered during the course of this investigation, it was learned that the follow-up medical visit for the X-Ray was conducted and completed on 06/01/2026 by Welbe Health. The results concluded that there was no medical evidence to support that R1 had sustained any injuries related to a fracture at that time. Based on interviews that were conducted during the course of this investigation, it was learned that the origin of the bruising sustained by R1 was unknown. It was learned that R1 was diagnosed with dementia, along with a language barrier present, made it more difficult for facility staff to gather a reliable account from R1. It was learned that R1 initially stated that R1's son was the cause for the bruise. Afterwards, R1 changed R1's statement indicating that R1 had bumped into a wheelchair with their forearm and sustained the bruise in that manner. Later on that same day, it was learned that R1 recanted all of the previous statements and denied any knowledge of how the bruising came about. It was learned that staff, upon the discovery of the bruising, did take the necessary procedures to seek first aid to reduce any discomfort and pain. In addition, the appropriate notifications were made to upper management and the responsible party for R1 as well. It was learned that the Unusual Incident Report (UIR) was completed and submitted into CCL by the required time frame for this incident that took place involving R1. As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 1, 2026 · control 27-AS-20260601104754

Allegation investigated: Staff did not provide appropriate care and supervision to resident Staff did not treat resident with respect Staff did not ensure resident PRN medication were given Staff did not refill resident medications timely

Unannounced complaint visit made out to this facility on 07/01/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was interviewed at this time. Current census was 48 residents. The purpose of this visit was to deliver the findings from this investigation to this facility, and its representative, at this time. Based on a review of the forms and documents gathered during the course of this investigation, it was learned that this facility employed (3) shifts for the AM, PM, and NOC hours throughout the day. It was learned that staffing consisted of facility caregivers who performed tasks of daily living for the residents in care. In addition, this facility also employed medication technicians who handled, dispensed, and documented all transactions involving the residents' medications which were centrally stored at this time. Based on a review of the forms and documents gathered during the course of this investigation, it was learned that there were roughly 11 caregivers and 5 dedicated medication technicians on staff at this time Unsubstantiated as supported by the LIC 500 that was completed and submitted into CCL on 03/16/2026. Based on a review of the forms and documents gathered during the course of this investigation, it was learned for the month of February 2026 that a review of 25 resident Medication Administration Records (MARs) conducted revealed that all medications were properly administered and documented as such. From the 25 MARs reviewed, it was learned that only 4 of those residents requested for their PRN medications to be dispensed to them at that time. It was learned that the PRN medications were available on hand to be dispensed as needed by the residents in care. It was learned that the primary medications which were prescribed to be dispensed on a daily basis to the residents in care were available on site and dispensed properly with documentation to support that these tasks were completed. It was learned that changes to the medications were properly noted and transferred into the E-MAR system that this facility employed at this time. It was learned that changes or discontinuances to the resident medications were properly noted and transferred into the E-MAR system that this facility employed at this time. Based on interviews that were conducted during the course of this investigation, it was learned that facility residents felt safe in this environment. It was learned that facility residents felt safe enough to ask for help from the facility staff and would receive that assistance in a timely manner without any resentment or attitude from them. Based on interviews that were conducted during the course of this investigation, it was learned that facility staff were expected to maintain a certain level of professionalism and carried themselves in that manner at all times when present at this facility. It was learned that there were dementia residents and residents with a higher level of need which required staff to be more patient and understanding of these special circumstances. It was learned that staff were expected to always exercise patience and dedication at all times when dealing with these types of more difficult circumstances. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegations finding of Unsubstantiated meant that although the allegations may have happened or were valid, there was not a preponderance of the evidence to prove that the alleged violations occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 1, 2026 · control 27-AS-20260505103727

Allegation investigated: Staff are mismanaging resident medication

Unannounced complaint visit made out to this facility on 07/01/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was interviewed at this time. Current census was 48 residents. The purpose of this visit was to deliver the findings from this investigation to this facility, and its representative, at this time. Based on a review of the forms and documents gathered during the course of this investigation, it was learned for the month of February 2026 that a review of 25 resident Medication Administration Records (MARs) conducted revealed that all medications were properly administered and documented as such. From the 25 MARs reviewed, it was learned that only 4 of those residents requested for their PRN medications to be dispensed to them at that time. It was learned that the PRN medications were available on hand to be dispensed as needed by the residents in care. It was learned that the primary medications which were prescribed to be dispensed on a daily basis Unsubstantiated to the residents in care were available on site and dispensed properly with documentation to support that these tasks were completed. It was learned that changes to the medications were properly noted and transferred into the E-MAR system that this facility employed at this time. It was learned that changes or discontinuances to the resident medications were properly noted and transferred into the E-MAR system that this facility employed at this time. As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 1, 2026 · control 27-AS-20260306164804

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct an case management visit. LPA met with Administrator Prithika Singh and explained the reason for the visit. Census: 43 On August 25, 2025, LPA Lund delivered an Order to Licensee/Facility of Immediate Exclusion to the facility for Staff (S1). As a result of an investigation by the California Department of Social Services (CDSS). It has been determined that S1 has engaged in conduct inimical as a caregiver. It has been determined that S1 will have no contact with residents at any licensed facility by CDSS. An exit interview was conducted with Administrator Prithika Singh. A copy of this report and Order to Licensee/Facility of Immediate Exclusion from the facility for S1 was provided.the state’s words, verbatim · CDSS document, Aug 25, 2025

Type of visit: Prelicensing

On 05/16/2025, at 9:15 am, Licensing Program Analyst (LPA), Renee Campbell arrived unannounced to conduct an inspection to the above facility for the purpose of a pre-licensing evaluation. This pre-licensing is for Change of Ownership (CHOW) to Deer Tail Living Inc. DBA Vintage Faire Residential. LPA met with Administrator Prithika Singh, Francis Santillian, Marketing and Eric Olson with Marketing and explained the purpose of the visit. LPA Campbell inspected the physical plant of the facility to ensure compliance of Title 22 regulation. LPA observed 5 random resident units, the activity room, dining room, kitchen, laundry, and outdoor areas. The Facility has a 49-resident capacity for Assisted Living residents. The facility is a one-story building located in a residential neighborhood. Outdoor passageways, walkways, driveways, and steps are free from obstructions. LPA Campbell did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Bodies of water were not observed at this time. Resident Bedrooms: LPA inspected 5 resident units. Each unit is fire cleared for non-ambulatory residents. The resident apartments/units are spacious and will easily accommodate the residents furnishings. The inspected resident units were observed to be furnished with adequate storage for resident belongings. Bathroom: Each resident unit contains a private bathroom. All bathrooms inspected have working toilets, wash basins and full baths have showers. There are grab rails next to both the toilets and the showers as well as nonskid flooring. Toxins and Chemicals: Toxins and chemicals for cleaning are properly stored, locked, and inaccessible to residents in care. . Water temperature: Water temperature in 2 randomly selected bathrooms (in a resident units) were measured at 117.9 in room #7 and 116.1 degrees F in room #8. Food Service and Kitchen: The kitchen area and dining area were inspected and observed to be in good repair. Knives, cutlery and other sharp kitchen utensils are locked and inaccessible to residents. The food supply was adequate and stored in kitchen refrigerator and walk-in pantry and consists of the following: A variety of fresh and canned fruit, vegetable and meat food items. The date of purchase was written on food items in the refrigerator and freeezer. Stove burners and oven were observed to be in good repair. Temperature in freezer was observed to be within regulatory standard -1.3 degrees Fahrenheit for the freezer. Menu was observed outside of the dining rooms and available for viewing to residents in care. LPA Campbell observed admission sheets over the food prep area to inform staff of new resident's dietary needs. Smoke Detectors/Carbon Monoxide: Each inspected resident units were observed to have a smoke detector and carbon monoxide detectors. Additionally, facility is equipped with sprinkler system. Smoke detectors are hardwired and interconnected, and they are fully operational. Facility conducts quarterly smoke alarm testing. The most recent test occurred 02/18/2025 and was passed successfully. Medications and First-Aid Kit: Resident medications were observed to be stored in the medication room and locked and inaccessible to residents in care. The first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and manual which are stored in the locked medication room. A first aid kit is also kept in the Administrator's office and available for staff use but inaccessible to clients. Facility, Residents & Staff Files: Facility will not be handling cash resources of residents. Records of staff and residents are stored in a locked room and accessible to staff. LPA Campbell reviewed 4 resident files that were found to be complete. Component III: Conducted at the Pre-Licensing visit, on 05/16/2025 at Vintage Faire Residential and information provided about how to operate the facility within substantial compliance. Pre licensing is complete and this facility has no deficiencies. An exit interview was conducted with Administrator Prithika Singh. A copy of this report was provided. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, May 16, 2025