496803049-9-30-2020-21-AS-CMAZ-BU92S4-20201009173829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803049
Report Date: 09/30/2020
Date Signed: 09/30/2020 05:21:34 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2020 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20200825152345

FACILITY NAME:	VARENNA AT FOUNTAINGROVE		FACILITY NUMBER:	496803049
ADMINISTRATOR:	BUOT, FERDINAND		FACILITY TYPE:	741
ADDRESS:	1401 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 526-1226
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	322	CENSUS:	DATE:	09/30/2020
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Ferdinand Bout		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident's do not receive adequate food service

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert met with Administrator FerdinandBout for the purpose of delivering findings on the above captioned complaint allegation. The visit was conducted via tele-visit due to COVID - 19 precautions. LPA did not physically present at the site. An anonymous complainant has alleged that the facility does not provide a sufficient variety of fresh fruits and vegetables and that food is cold when delivered to the residents' rooms. In response to the complaint, this Department has interviewed a sampling of residents; reviewed menus and purchasing invoices for the recent past; and questioned Administration and staff regarding the policies and practices effecting food service. The following determinations have been made: Record reviews show that a sufficient variety of fresh fruit and vegetables has been procured by the facility for service to the residents; The majority or residents interviewed state that they are very satisfied with the food service in contrast to the Complainant's allegations; Some residents state that food served on trays to the residents' rooms is warm and requires heating up prior to consumption but indicate that the facility is doing a good job and that COVID-19 precautions has required some adaptations to the regular food service;
****CONTINUED ON SECOND PAGE*****

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020

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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Control Number 21-AS-20200825152345

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: VARENNA AT FOUNTAINGROVE	FACILITY NUMBER: 496803049
	VISIT DATE: 09/30/2020

NARRATIVE

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General Food Service Regulations (87555) recognizes the "temporary need for tray service," and it appears that the food is "selected, stored, prepared, in a safe and Healthful manner. It further appears that the facility is in full compliance with the requirements of 87555.

Based upon interviews with staff and residents, as well as a review of facility records; pertinent regulations; and specific menus and purchasing invoices, we have found the allegation to be UNFOUNDED, meaning that the allegation is false, did not happen, or is without a reasonable basis.

No deficiencies noted at this time. Copy of report provided to the facility.

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020

LIC9099 (FAS) - (06/04)

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