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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 08/28/2025
Date Signed: 08/28/2025 03:00:34 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
06/09/2025 and conducted by Evaluator Shannan Hansen
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250609114333
FACILITY NAME:VINEYARD AT FOUNTAINGROVE, THEFACILITY NUMBER:
496803698
ADMINISTRATOR:DOWNEY, DENISEFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:64CENSUS: 25DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Denise Downey, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff left medication out accessible to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shannan Hansen was at facility conducting Annual inspection and delivered complaint findings regarding the allegations listed above. LPA met with Administrator, Denise Downey.

Complainant alleges staff (S1) left medication out for residents to get into, follow up interview with complainant included leaving medications on handrails in hallways and in resident rooms. During the course of the investigation LPA conducted visits on 6/17/2025, 7/15/2025, 7/29/2025, and 8/7/2025 not observing any medications left out in hallways or resident rooms toured. Medication records were reviewed and staff interviews were conducted. Nine staff interviewed finding only one previous staff and a current staff who had texted management they had found a white pill in a resident room and a small glass vile/bottle with an orange top and picked them up but did not indicate S1 had left them out. Seven of the nine staff interviewed have not observed any medications left out accessible to residents to get to.
Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Shannan Hansen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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 2
Control Number 21-AS-20250609114333
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: 08/28/2025
NARRATIVE
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Continued from LIC9099

LPA conducted interview with Administrator who received the text and informed after text received retraining of all med techs on medications handling was received. Investigation revealed conflicting information from staff investigations without any other corroborating evidence. There was not sufficient information obtained to support a violation occurred. Therefore, the allegation Staff (S1) left medication out accessible to residents 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: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
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