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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 374700126
Report Date: 11/18/2024
Date Signed: 11/18/2024 10:03:27 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/18/2024 10:03 AM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:VINTAGE HOME CAREFACILITY NUMBER:
374700126
ADMINISTRATOR/
DIRECTOR:		CYNTHIA GRAPEFACILITY TYPE:
300
ADDRESS:316 CRESTVIEW DRIVETELEPHONE:
(619) 271-3834
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: CENSUS: DATE:
11/18/2024
Required - 2 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cynthia GrapeTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On November 18, 2024, Home Care Services Bureau (HCSB) Enforcement Analyst, Adrian Mangina arrived at the business office of Vintage Home Care for a Biennial inspection. Upon arrival, the Enforcement Analyst identified herself and was greeted by Designee Stephanie Harrow. Licensee Cynthia Grape participated by telephone. Licensee operates the Home Care Organization out of the Residential Care for Elderly (RCFE) Home License #374603126 at the same address.

Analyst Mangina observed the proper posting of business hours and license. Analyst was provided an area in which the review of personnel and administrative files could be performed. Designee Harrow provided Analyst with current Certificate of Insurance showing that professional liability policy, worker's compensation, and dishonesty bond are current. No Home Care Aide files were reviewed as there are currently no Home Care Aides employed and no clients in care.

Upon completion of the file review Analyst discussed the findings of the inspection with Designee Harrow and informed Designee that no discrepancies were found.

LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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