496803049-3-13-2025-21-AS-CMAZ-DJERPJ-20250709131201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803049
Report Date: 03/13/2025
Date Signed: 03/13/2025 05:21:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2025 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20250307080406

FACILITY NAME:	VARENNA AT FOUNTAINGROVE		FACILITY NUMBER:	496803049
ADMINISTRATOR:	BUOT, FERDINAND		FACILITY TYPE:	741
ADDRESS:	1401 FOUNTAINGROVE PKWY		TELEPHONE:	(801) 815-0808
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	322	CENSUS:	DATE:	03/13/2025
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Ferdinand Buot-Administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility staff are not safeguarding residents personal property and personal space

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a complaint visit, on 3/13/25 at approximately 9:20am, and met with Executive Director/Administrator Ferdinand Buot, and Administrator Assistant Don Rodreick.

Reporting party alleges that the facility staff are not safeguarding residents personal property and personal space.

LPA reviewed resident (R1) records, including incident reports and admission agreement. LPA reviewed facility records, including facility's policy and procedures regarding theft & loss, safeguarding residents personal property. The LPA requested copies of records; Administrator provided copies to the LPA during the inspection.

The LPA reviewed records, conducted interviews with staff, and other related parties. The investigation revealed that R1 had reported a missing bracelet; The Police Officer that came out to the facility to do an investigation report was permitted by R1 to conduct a search in resident's unit; The Police Officer found R1's bracelet, R1 confirmed it was the bracelet that had been report missing. The LPA's investigation found that some of the cooking spices had been brought in by R1's visitors they had over in the recent past.
Continued on LIC9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

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 21-AS-20250307080406

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VARENNA AT FOUNTAINGROVE	FACILITY NUMBER: 496803049
	VISIT DATE: 03/13/2025

NARRATIVE

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The investigation found no information obtained on clothing being put in R1's closet that doesn't belong to R1. There was no information obtained regarding over-the-counter (OTC) medications being put into R1's unit. LPA interviews relayed that the over-the-counter medications found by R1 in the unit had been discarded. There was no information obtained regarding if anyone is coming into R1's unit throwing away OTC medications/supplements, bringing clothing into R1's closet, No information was obtained in the investigation to support a violation (s) had occurred regarding the allegation (s).

Based on the interviews, and related information obtained during the investigation, the allegation (s) of "facility staff are not safeguarding residents personal property and personal space" is Unsubstantiated, meaning that although the allegation (s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur.

No deficiencies cited.
Exit interview was conducted with the Administrator Ferdinand Buot.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025

LIC9099 (FAS) - (06/04)

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