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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203197
Report Date: 10/11/2024
Date Signed: 10/14/2024 01:56:18 PM


Document Has Been Signed on 10/14/2024 01:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:VINTAGE GARDENSFACILITY NUMBER:
107203197
ADMINISTRATOR:GEBBIA, LOUISFACILITY TYPE:
740
ADDRESS:540 S. PEACHTELEPHONE:
(559) 252-4036
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:158CENSUS: 63DATE:
10/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Louis GebbiaTIME COMPLETED:
10:30 PM
NARRATIVE
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On October 11, 2024, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced Case Management inspection and met with Administrator, Louis Gebbia. A prior visit was attempted on October 10, 2024, but due to computer issues, LPA was unable to produce a report.

The purpose of the visit was to discuss late incident reporting. On September 15, 2024 four incident reports were submitted by Vintage Gardens to Community Care Licensing (CCL) and all four were past the seven day reporting requirement. Administrator was aware of the issue and as a result conducted a training review for the staff that generate reports. Going forward staff will submit all incident reports timely, will fax and utilize the phone line to report to CCL and copy the Administrator for his review. A citation will be issued at today's visit and Plan of Correction will be cleared as well.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/14/2024 01:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: VINTAGE GARDENS
FACILITY NUMBER: 107203197

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/11/2024
Section Cited
CCR
87211(a)(1)(D)

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(1) A written report shall be submitted to the licensing agency... within 7 days of the occurrence of any of the events specified... below...(D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by
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Administrator stated that as soon as he was aware of the issue, he provided refresher training regarding reporting requirements to the three staff that submit reports. He will review all reports for timeliness and content going forward. POC to be cleared at today's visit.
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On September 15, 2024, CCL received four Incident reports that were past due and incomplete. This poses a potential threat to the health, safety and welfare of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2024
LIC809 (FAS) - (06/04)
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