496803698-12-31-2020-21-AS-CMAZ-BX4RST-20210109121717

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 12/31/2020
Date Signed: 12/31/2020 09:16:13 AM

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
10/05/2020 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20201005134434

FACILITY NAME:	VINEYARD AT FOUNTAINGROVE, THE		FACILITY NUMBER:	496803698
ADMINISTRATOR:	EDWARDS, SUSAN		FACILITY TYPE:	740
ADDRESS:	200 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 544-4909
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	64	CENSUS:	DATE:	12/31/2020
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Jennifer Mendoza/Staff		TIME COMPLETED:	08:45 AM

ALLEGATION(S):

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Staff fail to meet residents' hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert met with Jennifer Mendoza this date, for the purpose of delivering findings on the above captioned complaint allegation. The visit was conducted via tele-visit due to the COVID-19 precautions. This complaint alleges that residents are not bathed regularly and that the incontinent care is insufficient. During the course of the investigation, this Department has obtained and reviewed documents and records, as well as interviewed staff and witnesses. The following determinations have been made: Some podiatric services were curtailed due to Covid-19 precautions which was beyond the control of the administration and did effect the frequency of specialized foot care; Although staff are trained to deal with oppositional behaviors, some residents refuse bathing and foot care, such as cutting nails; Some residents and/or responsible persons do not want residents to be disturbed when sleeping in order to receive toileting/incontinent care; Such refusals of care are resident rights protected by regulation; Resident care plans and facility policies were reviewed and it was found that the records were complete as required; Training is provided to staff that provide care and supervision in the areas of incontinent care; residents' rights, dementia, oppositional behaviors and other topics. While photographs submitted to this Department depict wet diapers and resident's feet in need of

Unsubstantiated

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: 12/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2020

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-20201005134434

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: VINEYARD AT FOUNTAINGROVE, THE	FACILITY NUMBER: 496803698
	VISIT DATE: 12/31/2020

NARRATIVE

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additional care, it has not been found that sufficient evidence exists to find that the facility staff have failed to meet the residents' hygiene needs. Although the allegation may be valid, based upon the interviews and records reviewed, there is not a preponderance of evidence to prove the allegation did, or did not, occur. Therefore, the allegation in UNSUBSTANTIATED.

No citations issued today.

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2020

LIC9099 (FAS) - (06/04)

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