496803698-1-30-2025-21-AS-BMOS-DDJU8X-20250203142217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 01/30/2025
Date Signed: 01/30/2025 03:10:41 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, 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
11/20/2024 and conducted by Evaluator Marisol Cuadra

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20241120120743

FACILITY NAME:	VINEYARD AT FOUNTAINGROVE, THE		FACILITY NUMBER:	496803698
ADMINISTRATOR:	ANTONETTE EDWARDS		FACILITY TYPE:	740
ADDRESS:	200 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 544-4909
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	64	CENSUS: 25	DATE:	01/30/2025
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Denise Downey (Executive Director)		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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-Facility staff are not meeting residents care needs.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Cuadra and Deniz arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Denise Downey (Executive Director).

The Department received an allegation of facility staff are not meeting residents care needs. The Reporting party raised concerns about staff (S1) continues to be employed at this facility after several complaints made to management and community care licensing regarding their neglect with the residents. S1 does not change the residents or rotate their position in a timely manner. The reporting party have observed residents with incontinence care needs not been met for the eight hours where S1 works, and only changes them 30 minutes before their shift is about to end. By then the residents are completely soaked, and so is their bedding. Some of the residents that S1 considers to be more difficult to change, will not be changed at all. For the majority of S1’s shift had been observed either sleeping or on their phone. Per the reporting party residents are getting fungal infections and sores from not being changed on time or even changed at all.
Continued on LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

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-20241120120743

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VINEYARD AT FOUNTAINGROVE, THE	FACILITY NUMBER: 496803698
	VISIT DATE: 01/30/2025

NARRATIVE

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Continued from LIC9099...

The reporting party provided written communications to management dated 12/4/24, 12/2/24, 11/27/24, 10/29/24, 10/22/24, 10/21/24, 9/3/24 regarding alleged incidents involving S1. Based on interviews conducted with residents (R1 & R2) and staff (S2 & S9) did not reveal any supporting evidence due to the very limited information obtained from interviews with residents and staff who indicated there were some challenges with some of the night shift staff including S1, but they were related to their attendance. According to the Administrator, there were concerns raised regarding S1’s performance and an undocumented internal investigation was conducted briefly with night shift staff, but based on verbal statements obtained by their staff, the results of the investigation were unfounded. The facility has been experiencing management turnovers over the last couple months and managers who were handling this issue and who were noted in the written communications emails sent to them around S1’s performance does no longer work at the facility. New management claims that they were not aware of these incidents. However, they were able to provide LPA with a resignation letter dated 12/12/2024 from S1 giving their two-week notice without a reason. LPA attempts to contact to S1 were unsuccessful. Therefore, LPA was unable to determine if allegation could happen at a prior date by S1 who were working the night shift during the time of the alleged incidents. A finding that the complaint allegation occurs of facility staff are not meeting residents care needs is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025

LIC9099 (FAS) - (06/04)

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