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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 08/07/2025
Date Signed: 08/07/2025 03:07:37 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
05/21/2025 and conducted by Evaluator Shannan Hansen
COMPLAINT CONTROL NUMBER: 21-AS-20250521082833
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:
08/07/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Denise Downey, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff hit resident
Staff inappropriately spoke to resident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Hansen arrived unannounced to deliver complaint investigation findings regarding the above allegations and met with Denise Downey, Administrator.

Staff hit resident – Complainant alleges "around two weeks ago" (RP doesn't know the date), staff S1 "smacked" Resident (R1) on the shoulder. Follow up interview with complainant further informed, they saw S1 opened hand hit R1’s face/neck approximately 3 weeks to 1 month ago. Also alleged, Staff inappropriately spoke to resident – Complainant alleges S1 told R1 "Be nice" because R1 became agitated and cursed at S1. During the investigation staff interviews were conducted and 5 staff statements were obtained along with facility records, police report and follow up with county district attorney. It is alleged that between approximately April 17th and April 30th 2025 S1 hit and spoke inappropriately to R1, although schedule review of April shows R1 is part of Care Group 1 and only worked 2 days with Group 1 within that time period. Written statements from staff members working those days revealed no other staff witnessed S1 every hit or speak inappropriately to any resident. Continue on LIC9099-C
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)
Page: 1 of 2
Control Number 21-AS-20250521082833
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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Continue from LIC9099

Based on interviews, documents obtained and correspondence with district attorney office there is no evidence to prove or disprove above allegations occurred.

Based on interviews conducted & statements obtained, record/document reviews, and related information obtained during the investigation, the allegations Staff hit resident & Staff inappropriately spoke to resident is Unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies cited.

Exit interview was conducted with the Administrator

LPA will be conducting a case management regarding mandated reporting requirements.

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)
Page: 2 of 2