<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 03/21/2025
Date Signed: 03/21/2025 02:35:48 PM

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
12/27/2024 and conducted by Evaluator Shannan Hansen
COMPLAINT CONTROL NUMBER: 21-AS-20241227111202
FACILITY NAME:VINEYARD AT FOUNTAINGROVE, THEFACILITY NUMBER:
496803698
ADMINISTRATOR:SANDHU,RAJVIRFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:64CENSUS: 22DATE:
03/21/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:CEO of One Life Senior Living, Dan Williams , VP Quality Assurance, Joe Diagle of Frontier Living, and Administrator, Denise Downey, One Life Senior Living LLCTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident was provided clean linen
Staff did not ensure resident's room is free of odor
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
While conducting Office meeting at the Santa Rosa Regional Office findings of the investigation were delivered.

Reporting Party alleges on 12/24/2025 resident (R1)’s room smelled so badly of urine that it made outside providers eyes water due to bedding being soaked with urine. The department conducted a visit on 12/31/2024 and observed no linens on R1’s bed they were in. Interview conducted with R1 on 1/9/2025 revealed they did not have linens on the bed. LPA’s interviews with Business Office Manager revealed when they were informed of the incident on date in question R1’s room did smell of urine.
Allegations, Staff did not ensure resident was provided clean linen & Staff did not ensure resident’s room is free of odor is found to be SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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-20241227111202
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: 03/21/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC9099


The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 21-AS-20241227111202
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: 03/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/24/2025
Section Cited
CCR
87625(b)(3)
1
2
3
4
5
6
7
87625(b)(3) Managed Incontinence. … the licensee shall be responsible for the following: Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.
1
2
3
4
5
6
7
Administrator to submit a plan or correction that addresses how the facility will comply with the requirements of 87625 going forward. Written plan to be submitted to CCL by POC date in order to clear this deficiency
8
9
10
11
12
13
14
****Based upon statements & interviews, this requirement has not been met as evidenced by: R1’s bedding was noted to smell of urine on 12/24/24 by outside provide & interviews conducted with staff. This posed an immediate risk to health and personal rights of clients in care.
8
9
10
11
12
13
14
Type B
03/28/2025
Section Cited
CCR
87307(a)(3)(a)
1
2
3
4
5
6
7
87307 Personal Accommodations and Services (a)(3)(a)...Living accommodations. The following provisions shall apply:(3) Equipment... personal care and maintenance...each resident...provide the following.. (C)Clean linen, including..top bed sheets, bottom bed sheets,...The linen shall be in good repair.
1
2
3
4
5
6
7
 Licensee to send in written plan on how they will ensure staff follow requirement and stay in compliance. POC due date. 3/28/2025
AND
8
9
10
11
12
13
14
This requirement has not been met as evidence by: Based on observat & interview R1 did not have any bed linens on 12/31/24 as observation by Licensing Program Analyst & interviews conducted, Licensee did not provide the resident required bed sheets which poses a potential health, safety, and personal rights risk to clients in care.
8
9
10
11
12
13
14
Licensee to submit proof of supply of the proper bed linens required and photos documenting that beds are made correctly with the required bed linens submitted to CCL by 3/28/2025
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: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3