496803698-8-7-2025-21-AS-BMOS-DKFQSR-20250811122559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 08/07/2025
Date Signed: 08/07/2025 03:06:44 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
07/29/2025 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20250729145231

FACILITY NAME:	VINEYARD AT FOUNTAINGROVE, THE		FACILITY NUMBER:	496803698
ADMINISTRATOR:	DOWNEY, DENISE		FACILITY TYPE:	740
ADDRESS:	200 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 544-4909
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	64	CENSUS: 25	DATE:	08/07/2025
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Denise Downey, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Licensee does not include facility license number on advertisements made with the intent to attract clients or residents
Licensee does not have the required information posted prominently in an area that is accessible to residents, representatives, and the public

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to initiate a complaint investigation and delivered findings regarding the allegations listed above. LPA met with Administrator, Denise Downey.
During investigation LPA made observations, reviewed documents and conducted interviews.

Complainant alleges the licensee does not include facility license number on advertising materials such as website and brochures. On August 6, 2025 LPA reviewed facility website finding facility License number in 4 different locations (see pics). On 8/7/2025 while at facility investigating complaint allegations, Administrator presented brochures that also have current license number on them. Administrator informed, “We do not advertise for the soon to be new License "The Reserve at Fountaingrove" because licensing has not approved the Change of Ownership (CHOW) yet”.
LPA advised Administrator, per Title 22 regulation 87206, while the application of the new license is pending, the facility should continue to operate under the old license number. Correspondence to the public and Licensing should continue to indicate license #496803698. Continue on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

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-20250729145231

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: 08/07/2025

NARRATIVE

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Continued from LIC9099

Complainant also alleges the facility does not post the required posters and information about residents’ rights. While touring facility on 8/7/2025 at 1:30pm LPA observed 2 Residents rights posting from CCL of required PUB-478 and 2 Long Term Care Ombudsman (LTCO) required postings (see pics) 1) on the east side of the building where (residents currently are residing) as you first walk in is both a CCL PUB (See Something /Say Something ) on the immediate right wall and on the left wall also a large posting for LTCO as required that residents & guests, family members can observe. 2) There is also a CCL See Something Say Something posting in East communal dining room and a LTCO posting in the back hall.

There was no information obtained during the investigation that supported a violation had occurred. Therefore, the allegation Licensee does not include facility license number on advertisements made with the intent to attract clients or Licensee does not have the required information posted prominently in an area that is accessible to residents, representatives, and the public is UNSUBSTANTIATED.

A finding that the complaint allegations are unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2025

LIC9099 (FAS) - (06/04)

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