496803698-5-17-2022-21-AS-HDBI-CERUM7-20220525154153

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 05/17/2022
Date Signed: 05/17/2022 10:21:11 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/05/2022 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20220105091927

FACILITY NAME:	VINEYARD AT FOUNTAINGROVE, THE		FACILITY NUMBER:	496803698
ADMINISTRATOR:	MOONEY, SHAWN		FACILITY TYPE:	740
ADDRESS:	200 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 544-4909
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	64	CENSUS: 44	DATE:	05/17/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Annet Nakiyuka		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility failed to safeguard residents belongings
Personal rights

INVESTIGATION FINDINGS:

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Licensing Program analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with the Administrator and discussed the findings. During the course of this investigation site visits were made, statements taken, and documents reviewed. The allegations that residents and others have stolen property belonging to R1 and that residents have entered R1's room uninvited and acted inappropriately have not been proven. It has been determined that R1's has a dementia diagnosis and has exhibited a pattern of making inaccurate allegations of theft; Although residents may have entered R1's room uninvited and violated R1's rights, no evidence of this was found during the course of the investigation. Although the allegations may be valid, there is not a preponderance of evidence to prove the allegations did, or did not, occur. Therefore, the allegations are UNSUBSTANTIATED.

No citations issued today.
Report left at facility.

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: 05/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022

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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