496803698-3-27-2024-21-AS-BMOS-D47T4E-20240410142349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 03/27/2024
Date Signed: 03/27/2024 03:31:14 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
08/03/2023 and conducted by Evaluator Shannan Hansen

COMPLAINT CONTROL NUMBER: 21-AS-20230803084501

FACILITY NAME:	VINEYARD AT FOUNTAINGROVE, THE		FACILITY NUMBER:	496803698
ADMINISTRATOR:	ERIC PERRY		FACILITY TYPE:	740
ADDRESS:	200 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 544-4909
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	64	CENSUS: 48	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Christina Cruz, Marketing Dir/Assist. ED		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility is in financial distress

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPAs) Hansen & Florio arrived unannounced on this day for the purpose of delivering findings of the above allegation. During the course of this investigation LPA conducted interviews, made observations and engaged the Departments Solvency Auditor to assist in determining if the facilty is experiencing finical distress. LPA met with Marketing Director/Assist. ED Christina Cruz.

The Departments Audit Section sent out an engagement letter and LIC 401 & LIC 403 form to Joseph Hansen, administrator on 12/28/2023. The facility did not provide the requested documentation failing to meet deadline on 1/29/2024. The Audit Section made second request on 2/20/2024 requesting compliance to determine solvency. Administrator deferred to corporate members and two additional requests were made on 2/9/2024 and 2/21/2024, facilty failed to meet deadline and provide requested information. LPA conducted interviews and information was provided in support that the facilty is experiencing financial distress.
Continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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-20230803084501

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: 03/27/2024

NARRATIVE

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Regional office will be requesting an office meeting to discuss non-compliance and concerns of facilities current solvency state. Continued non-compliance may result in administrative action.

The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. 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 right provided.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20230803084501

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: 03/27/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/28/2024 Section Cited CCR 87213	1 2 3 4 5 6 7	87213 Finances - The licensee shall have a financial plan that conforms to the requirements of Section 87155... & that assures sufficient resources to meet operating costs for care of residents... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Facility agrees to comply with Solvency Audit and submit requested documents to Department Auditor by 4/3/2024. Marketing Director/Assist. ED Christina Cruz agrees to provide Corporate Officers & Management Company reports from todays inspection to comply with POC and submit confirmation email to LPA by 3/28/2024.
	8 9 10 11 12 13 14	Based on records reviewed, statements received, and Licensee neglecting to respond to requested additional documents repeatedly from the Department, Licensee did not ensure the regulation above due to not having sufficient funds to meet operating costs as required. This is an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14	Also, Marketing Director/Assist. ED Christina Cruz agrees to provide LPA contact emails for Corporate and Management Company for the purpose of scheduling a Non-Compliance Conference meeting by POC due date also of 4/3/2024.
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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.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan Hansen	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

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