342701535-7-3-2025-27-AS-CTAO-DJ8LLY-20250703085152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701535
Report Date: 07/02/2025
Date Signed: 07/03/2025 08:52:47 AM

Document Has Been Signed on 07/03/2025 08:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	ERA AT VINTAGE PARK		FACILITY NUMBER:	342701535
ADMINISTRATOR/ DIRECTOR:	GREWAL, NISCHAY		FACILITY TYPE:	740
ADDRESS:	9723 VINTAGE PARK DR		TELEPHONE:	(707) 699-0775
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95829
CAPACITY: 6		CENSUS: 0	DATE:	07/02/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:02 AM
MET WITH:	Jaskaran Warraich		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On July 2, 2025 at 9:02 AM, Licensing Program Analyst (LPA) Cynthia Tamayo arrived announced to conduct a Pre-Licensing Inspection of the facility to ensure compliance with Title 22 regulations. LPA met with applicant, Jaskaran Warraich (Licensee/Administrator) and Nischay Grewal (Licensee) assisted LPA in today’s inspection. This Applicant is seeking a facility license for a Residential Care Facility for the Elderly (RCFE) with a capacity of six (6). The facility is one story home with five bedrooms and two bathrooms. The facility will not have live in staff and will provide 24/7 care to residents. Bedroom #1-4 is approved for non-ambulatory residents and bedroom #5 is approved for one (1) bed ridden residents .There were no residents at this time. A brief interview with applicants was conducted. Jaskaran Warraich will be the Administrator of this facility. The facility administrator’s certificate # is 6066509740 and will expire 6/30/2026. The facility has an infection control plan and an emergency disaster plan completed and provided to Licensing for approval. LPA toured the facility and inspected the kitchen area. Cabinets and drawers were opened and reviewed at this time. Silverware, plates, and utensils were observed to be sufficient to meet the needs of six residents. Knives were observed to be made inaccessible to the residents at this time. The food storage units and facility refrigerator was observed to be functional and in good repair at this time. LPA observed enough food supplies for 2-day perishables and 7-day non-perishable quantities. Continued on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Cynthia Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ERA AT VINTAGE PARK	FACILITY NUMBER: 342701535
	VISIT DATE: 07/02/2025

NARRATIVE

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LPA observed cleaning supplies and laundry supplies were stored inside locked cabinets in the laundry room as well as the garage which is kept locked and inaccessible to residents. The kitchen facucet water temperature measured at 107.8, which is within the required regulation of 105 to 120 degrees Fahrenheit. There was a water temperature of 108.1 degrees Fahrenheit for bathroom #1 and bathroom #2, which is within the required regulation of 105 to 120 degrees Fahrenheit.

The common area and dining area were observed to be furnished with enough seating to meet the needs of the 6 residents.

LPA observed a cell phone (707) 699-0775 made available to residents in the common area; The phone rang with an option to leave a voice message. The facility smoke detectors and carbon detectors were observed to be in good condition. The fire extinguisher is current and located in the laundry room next to the kitchen. Linen closet was observed in the hallway and had enough supply of sheets, bedding, pillowcases, and blankets to meet the needs of six (6) residents. Residents’ bedrooms were toured, and furniture and furnishings were observed to meet the needs of the residents.

LPAs observed the centrally stored medication areas to be locked near the dining area. LPA inspected the first aid kit, and it was complete. LPA observed there was enough supply of hygiene items on the premises made available to residents in care. LPA observed facility has a designated area for residents and staff files, which is kept locked. LPA also observed required posters posted. LPA toured the garage and observed washer and dryer and freezer in the garage with no accessible hazards. LPA toured the exterior physical plant and observed the back yard to have enough shade and furniture made available for residents. LPA observed a locked shed where gardening supplies and spare equipment is kept. LPA Tamayo observed there were two exit gates in the yard with self-latching mechanisms.

Licensee/Administrator will ensure to notify LPA once their first resident moves in.

A Component III was completed at this time with Nischay Grewal and Jaskaran Warraich. The applicant has passed the pre-licensing component of the application process. LPA Tamayo will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed. An exit interview was conducted, and a copy of this report was provided to the Applicant.

NAME OF LICENSING PROGRAM MANAGER: Czarrina A Camilon-Lee
NAME OF LICENSING PROGRAM ANALYST: Cynthia Tamayo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

LIC809 (FAS) - (06/04)

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