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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134602083
Report Date: 12/27/2021
Date Signed: 12/27/2021 04:27:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VINTAGE VILLAGE ASSISTED LIVINGFACILITY NUMBER:
134602083
ADMINISTRATOR:KARL BURNWORTHFACILITY TYPE:
740
ADDRESS:921 OCOTILLOTELEPHONE:
(760) 352-3818
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:6CENSUS: 0DATE:
12/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Olivia ChristTIME COMPLETED:
01:35 PM
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Licensing Program Analysts Sabel Martinez and Esther Miller, conducted an unannounced Case Management Visit.

The Licensee, Patricia Burnworth previously advised the Department of the facility closure earlier this year due to personal reasons, including the Licensee's sister-facility, Vintage Village 2 (134602319).

On October 22, 2021, LPM John Rante conducted a Case Management Visit to the Licensee's sister-facility (Vintage Village 2). LPM conducted a tour of the outside of the facility. In addition, LPM observed the inside of the facility from the front eastern living room window. Other than some furniture items positioned in the living room, it appeared as if there were no residents in care, nor any tenants residing at the property. The relocation information for the previous tenants were provided to LPM Rante.

In addition, the relocation information for the last residents at this facility (Vintage Village Assisted Living), was also provided to the Department.

LPAs Martinez and Miller were greeted by Olivia Christ, who stated the building is no longer used as a Residential Care Facility for the elderly (RCFE), and there are no clients at the facility. Ms. Christ is in charge of cleaning and preparing the facility to be sold. From the entry way, LPAs observed furniture and other items. It appeared as if the facility is being renovated, there were no residents in care, nor any tenants residing at the property.

No deficiencies were cited or observed on this date.

The Licensee will be provided a copy of their appeal rights (LIC9058 01/16). An electronic read receipt will serve as confirmation of receipt of documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021
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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