374603126-2-14-2022-08-AS-DPOL-CC3W3Q-20220228155619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603126
Report Date: 02/14/2022
Date Signed: 02/14/2022 03:00:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/05/2021 and conducted by Evaluator Anna Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20210105083826

FACILITY NAME:	VINTAGE RESIDENTIAL 1		FACILITY NUMBER:	374603126
ADMINISTRATOR:	GRAPE, CYNTHIA		FACILITY TYPE:	740
ADDRESS:	316 CRESTVIEW DRIVE		TELEPHONE:	(619) 271-3834
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY:	6	CENSUS: 6	DATE:	02/14/2022
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Cynthia Grape		TIME COMPLETED:	03:19 PM

ALLEGATION(S):

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Facility staff are not allowing resident to communicate with their family.
Facility is not allowing resident to have their personal possessions while at the facility.
Facility staff are not allowing resident to have visitations with their family.
Facility is not adhering to Admissions Agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kennedy conducted an unannounced complaint visit to deliver findings regarding the above allegations. LPA identified herself and was invited in to the facility.
LPA met with Cynthia Grape, Licensee and Administrator, and discussed the purpose of today's visit.

During the investigation LPA visited the facility, made observations, conducted interviews with internal and external sources.
The first allegation in this complaint was that the facility staff are not allowing resident to communicate with their family. Over the course of the investigation it was revealed that this allegation was based on some initial difficulty having the resident’s telephone line transferred to the resident’s room in the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022

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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Control Number 08-AS-20210105083826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VINTAGE RESIDENTIAL 1	FACILITY NUMBER: 374603126
	VISIT DATE: 02/14/2022

NARRATIVE

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By the time the LPA made contact with the facility, the issue had been resolved and the resident had their phone connected, with their prior phone number as desired by the resident. Although there were some challenges in getting the phone connected in the resident’s room, interviews did not reveal any evidence that the facility staff was not allowing resident-family communication. This allegation is unsubstantiated.

The next allegation of the facility not allowing a resident to have their personal possessions while at the facility was based on a concern that the resident had a bed that was not being used at the facility. Interviews revealed that the resident and their supporters made arrangements to move the bed and that the resident chose to stay in a bed provided by the facility stating that the resident is happy with the mattress they were using. Although moving and storing the resident’s belongings was not smooth, there was no evidence to support the allegation that the facility was not allowing the resident to have their personal belongings at the facility. This allegation is unsubstantiated.

The allegation of the facility staff not allowing resident to have visitations with their family had to do with COVID precautions. One of the resident’s family members had symptoms that were consistent with COVID and was told by the facility not to visit. Another family member came to the facility without a mask and was required to mask-up prior to entry. Interviews revealed that individuals did have their access to face-to face visits with the resident restricted to comply with COVID mandates, visits could resume with all COVID precautions in place. This allegation is unsubstantiated.

Lastly is was alleged that facility is not adhering to Admissions Agreement, specifically about food service. The resident has specific tastes that may not be consistently aligned with the facility’s regular menus. The interviews revealed that the administrator is willing to accommodate the resident’s palate, however the resident prefers to make dietary requests of a family friend. The administrator facilitates the storing and serving of any foods designated for this individual resident. This allegation is unsubstantiated.

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210105083826

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VINTAGE RESIDENTIAL 1	FACILITY NUMBER: 374603126
	VISIT DATE: 02/14/2022

NARRATIVE

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Based on interviews and LPA observations, the above allegations have been determined to be unsubstantiated. Meaning there is not a preponderance of the evidence to prove that the alleged violation occurred.

This report was discussed with Cynthia Grape, Licensee and Administrator. A copy along with Licensee Rights (01/2016) was emailed to Ms. Grape at the conclusion of the visit. An electronic response confirms the receipt of these documents.

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022

LIC9099 (FAS) - (06/04)

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