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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 01/09/2025
Date Signed: 01/09/2025 11:32:41 AM

Substantiated


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
11/19/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20241119162140
FACILITY NAME:VINEYARD AT FOUNTAINGROVE, THEFACILITY NUMBER:
496803698
ADMINISTRATOR:ANTONETTE EDWARDSFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:64CENSUS: 26DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Denise Downey (Executive Director) and Business Offica Manager, Serina BarredaTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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-Facility failed to notify residents of the sale of the property.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Marisol Cuadra and Robert Frank conducted an unannounced visit and met with Business Offica Manager, Serina Barreda and Denise Downey, Executive Director.

The Department received an allegation of facility failed to notify residents of the sale of the property. On 11/19/24 the reporting party have raised concerns about the facility have been sold without notifying the residents. Per reporting party, they heard the news from three people including one staff. On 11/25/24, LPA conducted 10-day and conducted interviews with acting Administrator who provided LPA with a letter from new management dated 11/20/24 addressed to residents and their responsible parties notifying them that there was a new management company for the facility, the transition is set to take effect January 1st, 2025 (or upon approval by the state of California). Based on records review of facility admission agreement revised 05-20-2022, appendix B pg#35 states the following: “TERMINATION DUE TO LICENSE FORFEITURE OR CHANGE OF USE 1.
Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20241119162140
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: 01/09/2025
NARRATIVE
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Continued from LIC9099...

Upon sixty (60) Days Written Notice. We may terminate this Agreement upon sixty (60) days’ prior written notice to you or your representative, if any, if the following events occur: (b)Change of use of the Community. 2. Notice. If we terminate this Agreement under Section 1 above, you and your representative, if any, shall receive a notice of the reason for the termination, with specific facts to permit a determination of the date, place, witnesses, and circumstances concerning the reasons. The notice will also include a copy of your current service plan, your relocation evaluation prepared by us (see Section 6 below), a list of referral agencies, and an explanation of your or your legal representative’s right to contact the California Department of Social Services (“DSS”) to investigate the reasons given for the termination. We will send to DSS a written report of the termination within five (5) days after issuing the termination notice”. However, the residents and their responsible parties were not notified timely about the sale of the property, the facility did not follow their own admission agreement and the letter sent on 11/20/24 wasn’t from current management company, and as of today the Department has not received a change of ownership application yet. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety Code is being cited on the attached LIC 9099D. Appeal Rights Given. The Department will be reviewing the information obtained to determine if further actions are needed.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20241119162140
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2025
Section Cited
CCR
1569.191(1)
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§1569.191 Sale of licensed facility…(1) The licensee shall provide written notice to the department...of the licensee's intent to sell the facility at least 30 days prior to the transfer of the property/business, or at the time that a bona fide offer is made, whichever period is longer. This requirement has not been met as evidence by:
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The Licensee will submit proof of change of ownership application to CCL by POC due date to clear the citation.
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Based on records review the residents and their responsible parties were not notified timely about the sale of the property, the facility did not follow their own admission agreement, which poses an immediate risk to the health and safety of the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3