107203197-7-13-2020-24-AS-AXIG-BRLSVX-20200717141327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107203197
Report Date: 07/13/2020
Date Signed: 07/13/2020 03:12:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/14/2020 and conducted by Evaluator See Moua

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20200514092528

FACILITY NAME:	VINTAGE GARDENS		FACILITY NUMBER:	107203197
ADMINISTRATOR:	GEBBIA, LOUIS		FACILITY TYPE:	740
ADDRESS:	540 S. PEACH		TELEPHONE:	(559) 252-4036
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	158	CENSUS: 77	DATE:	07/13/2020
		UNANNOUNCED	TIME BEGAN:	12:33 PM
MET WITH:	Louis Gebbia, Administrator		TIME COMPLETED:	12:34 PM

ALLEGATION(S):

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Residents not being provided their medications as prescribed.
Staff are falsifying medication administration records.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) S. Moua contacted the facility on this date telephonically due to COVID-19 precautionary measures. LPA spoke with Administrator Louis Gebbia and reviewed the allegations. Findings were delivered.

LPA interviewed facility staff about medications and staff denied the allegations. Resident's medications and MARs were review and all medications appeared to be given according to physician's orders. LPA did not observe any errors with resident's medication administrator records and could not determine that they were falsified. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. Exit Interview was conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda White	TELEPHONE: (559) 650-7908
LICENSING EVALUATOR NAME: See Moua	TELEPHONE: (559) 580-6596
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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