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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803698
Report Date: 04/17/2024
Date Signed: 04/17/2024 02:56:24 PM


Document Has Been Signed on 04/17/2024 02:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, THEFACILITY NUMBER:
496803698
ADMINISTRATOR:JOSEPH HANSENFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:64CENSUS: DATE:
04/17/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee, Greg Roderick, Irene Hernandez, Shari Michael, Elizabeth Simon, Jeff Putnam, Marisol Solis, Jennifer Rice, & Assistant ED Christina Cruz TIME COMPLETED:
02:30 PM
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
A Non-Compliance Conference was conducted today in the Santa Rosa Regional Office. Present in the meeting were, Regional Manager, Carla Nuti-Martinez, Licensing Program Manager, Bethany Moellers, Licensing Program Analyst (LPA) Shannan Hansen met with Facility: Licensee, Greg Roderick, Irene Hernandez, Shari Michael, Elizabeth Simon, Jeff Putnam, Marisol Solis, Jennifer Rice, & Assistant ED Christina Cruz for the purpose of reviewing issues during a Non-Compliance Conference.

This Non-Compliance Conference is being conducted to discuss concerns identified by the Community Care Licensing Agency regards to the operation of The Vineyard at Fountaingrove 496803698. Areas of compliance not limited to below were discussed:



· Financial Solvency
· Fire clearance concerns (Fire Department involvement) - POC not fully resolved
· Insufficient care and supervision & medication errors as previous multiple citations
· Administer duties/qualifications
· Licensing fees (late fees not paid 2nd notice sent)
· Facilities future compliance


TSP service: Licensee was informed of, and will inform if interested in engagement.
No deficiencies cited during the Non-Compliance Conference.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Shannan HansenTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1