Vintage House

Type of visit: Case Management - Annual Continuation

At approximately 09:20 AM, Licensing Program Analyst (LPA) Star Stevenson returned to CONTINUE the annual required inspection and met with caregiver Nerica "Janela" Rosales and responsible party (RP) who called Licensee Francisco "Kit" Roa who explained that he would not be available for today's continued inspection and gave permission for Nerica Rosales to assist. LPA observed that the threshold in main bathroom has been repaired with tape removed and tripping hazard removed. At approximately 9:45 AM LPA reviewed five (5) of five (5) resident files and found two (2) of five (5) missing records, as well as, one (1) of (5) missing evidence of MD/X-ray TB clearance. With resident one (R1) missing an Admissions Agreement (LIC604), Consent for Emergency Medical Treatment (LIC627C), Appraisal Needs and Service (LIC625) and Signed Personal Rights (LIC613C) and Resident two (R2) missing missing Physician TB clearance or chest X-ray indicating free from TB (two Type B deficiencies issued) Medicines were observed to be centrally stored and lock and medicine administration and records were observed to be accurate. Continued on LIC809C Continued from LIC809 Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/06/2025 1)Current Lease Agreement or evidence of Control of Property 2)Updated LIC308- Designation of Responsibility 3)LIC500- Personnel Report 4)Updated LIC610E- Disaster Plan 5)Updated Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Nerica "Janela" Rosales and Appeal rights were giventhe state’s words, verbatim · CDSS document, Oct 9, 2025

The state marks this report as 15 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 9:45 AM, Licensing Program Analyst (LPA) Star Stevenson BEGAN a required 1-year unannounced inspection of this licensed senior care facility. LPA met with caregiver Catalina Bueno-Salcedo (formerly associated with Vintage House as Catalina Sanchez) who has Designation of Facility Responsibility (RP). Catalina called licensee Roa Francisco who was not able to attend today's inspection and agreed to have inspection continue with RP. Vintage house is a Residential Care Facility for the Elderly (RCFE) with capacity for six (6) residents and can care for four (4) non-ambulatory residents in rooms one (1), two (2), & four (4) and has a hospice waiver for two (2). At approximately 10:20 AM, LPA toured the building and grounds which was found to be a comfortable temperature and without odors. LPA observed all walkways and exits to be unobstructed. LPA observed facility now has resident rights posted. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored and not accessible. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguisher inspected was charged and last inspected November 2024. Smoke detectors and carbon monoxide detectors were found to be in working order. Medicines are locked in entryway closet and no evidence of pre-pouring was observed. Licensee was advised to remove clear plastic tape and repair main bathroom threshold to reduce tripping hazard among elderly residents. Continued on LIC 809C Continued from LIC809... At approximately 11:30 AM, LPA reviewed five (5) staff files. Four (4) of five (5) staff files were noted to be missing records with S1 needing evidence of 40 hours of education/training having returned to work at Vintage House, S2 needing evidence of 1st Aid/CPR training, TB clearance, Job application and MD health screening. S3 is missing evidence of 1st Aid/CPR training and evidence of 20 hours of annual training and S5 missing evidence of TB clearance and 20 hours of annual training. (deficiencies cited) LPA will return at later unannounced date to complete inspection. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Current Lease Agreement or evidence of Control of Property LIC308- Updated Designation of Responsibility LIC500- Personnel Report LIC610E- Disaster Plan Updated Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Catalina Bueno Salcedo and Appeal rights were given.the state’s words, verbatim · CDSS document, Sep 30, 2025

The state marks this report as 15 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with caregiver Gerry Ofiza. At approximately 9:30AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. LPA observed facility did not have resident rights posted. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored and not accessible. Water temperature measured within regulation between 105 and 120 degrees F at faucets accessible to residents. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. LPA observed medication in small cups in a cupboard in the kitchen. The door to the cupboard was not secured. At approximately 10:00AM, LPA reviewed 3 of 3 resident records and found 3 of 3 residents did not have current care plans. 3 of 3 records contained current and signed admission agreements. There are currently no residents receiving Hospice services, however, 1 of 3 recently graduated from Hospice and there was no hospice care plan on file. At approximately 11:00AM, LPA reviewed 4 staff files. LPA did not find evidence of completed annual training in 4 of 4 files. LPA observed 3 of 4 staff had current First aid/CPR certification. Continued on LIC 809-C... At approximately 11:30AM, LPA reviewed the facility emergency disaster plan with staff. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Staff were not able to explain what to do in an emergency. Facility has not conducted and documented a disaster drill. Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: Current Lease Agreement or evidence of Control of Property LIC308- Designation of Responsibility LIC500- Personnel Report LIC610E- Disaster Plan Evidence of Liability Insurance Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Gerry Ofiza and Appeal rights were given.the state’s words, verbatim · CDSS document, Sep 27, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and was greeted by staff. Administrator, Francisco Roa was unable to come to facility but was available by phone and gave permission for staff to sign report. LPA initiated a tour of the facility around 10:30am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in bathroom used by residents measured at 108.6 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Facility does not have adequate emergency food and no emergency water supplies. Fire extinguishers were last serviced August 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational during inspection. Four staff files and four resident files were reviewed. Staff do not have required First Aid and CPR certificates or updated training records. Administrator Certificate for Administrator, Francisco Roa, 6005473740 is on the Department's pending list. Medication records were reviewed. Continued on LIC 809C Continued from LIC 809 Licensee/Administrator to submit updates of the following documents by 11/24/2023: LIC 500 Personnel Summary Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If any changes) Infection Control Plan (If any changes) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.the state’s words, verbatim · CDSS document, Oct 24, 2023