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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601158
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:19:49 PM

Document Has Been Signed on 10/25/2023 02:19 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:VINTAGE HOUSEFACILITY NUMBER:
198601158
ADMINISTRATOR:KARLTON A. LEVIASFACILITY TYPE:
735
ADDRESS:717 SOUTH BRADFIELD STREETTELEPHONE:
(424) 338-6422
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 4CENSUS: 3DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Karlton Levias TIME COMPLETED:
03:35 PM
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On 10/25/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Karlton Levias as the purpose of today’s visit was explained. The facility is licensed to serve four (4) developmentally disabled adults 18-59 years old. Clients are linked with the South Central Regional center. Current census is (3).

The facility is a one-story structure with 2 bedrooms and 1 bathroom, 1 linen closet in the hallway, living room, kitchen, laundry area, large backyard with a patio area and a detached garage that is used for storage of exercise equipment. There are no bodies of water or firearm/ammunition on the premises.



LPA conducted a records review of 2 staff records, 1 client record, and 1 medication administration records. No discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 09/15/23, (1) fire extinguisher fully charged and mounted in laundry area, carbon monoxide and smoke detectors observed and are operational. Landline and internet service was observed.

Client bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilet and water faucet worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F.. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Toxins and knifes were observed to be locked and inaccessible to residents. Exits/ Walkways around the facility were free of debris and hazards.

During today’s visit no discrepancy were observed.

Exit interview conducted with Administrator Karlton Levias, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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