496803698-4-9-2021-21-AS-HDBI-C2P4AP-20210503185617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 04/09/2021
Date Signed: 04/09/2021 06:33:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2021 and conducted by Evaluator Dina Alviso

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210407120351

FACILITY NAME:	VINEYARD AT FOUNTAINGROVE, THE		FACILITY NUMBER:	496803698
ADMINISTRATOR:	EDWARDS, SUSAN		FACILITY TYPE:	740
ADDRESS:	200 FOUNTAINGROVE PKWY		TELEPHONE:	(707) 544-4909
CITY:	SANTA ROSA	STATE: CA	ZIP CODE:	95403
CAPACITY:	64	CENSUS:	DATE:	04/09/2021
		UNANNOUNCED	TIME BEGAN:	04:45 PM
MET WITH:	Tyler Mason-Executive Director		TIME COMPLETED:	05:35 PM

ALLEGATION(S):

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Staff are not answering the facility's main phone line

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alviso conducted a televisit inspection, on 4/9/21 at approximately 4:45PM. LPA spoke with Executive Director, Tyler Mason. The inspection is being conducted by tele-inspection due to COVID-19. The reader is advised that the LPA did not physically make a site visit.
Executive Director (ED) Tyler Mason stated to the LPA that on Tuesday of this last week a staff/new receptionist came on duty in the morning, and as required, forgot to switch the PM/night shift mobile phone line back to ring to the main phone line. The receptionist staff failing to make the phone line switch caused all calls coming in to continue being routed to the night mobile phone with no answer. This also eventually caused the night mobile phone mailbox to become full, and no more messages culd be left. ED stated that all resident's responsible partys have the ED's contact number, and a family member contacted him to let him know that the front desk number is not being answered at all.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021

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-20210407120351

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: VINEYARD AT FOUNTAINGROVE, THE	FACILITY NUMBER: 496803698
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/09/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/13/2021 Section Cited CCR 87411(a)(e)	1 2 3 4 5 6 7	87411(a)(e) Personnel Requirements-General. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. In facilities licensed for sixteen (16) or more, the requirements of Section 87411(d) shall be met with planned on the job training program that utilizes orientation, skill training and continuing education.	1 2 3 4 5 6 7	Executive Director Tyler Mason will submit proof of the in-service training given to the staff/new receptionist regarding the phone procedures; Procedures including to switch over calls in the AM to ring on the main line as required. POC is due no later than 4/13/21.
	8 9 10 11 12 13 14	Executive Director Tyler Mason stated the main phone linew was not being answered tuesday of this last week due to a staff/new receptionist failing to switch the night mobile phone line back to the main phone line when coming on duty in the AM. This incident lasted approximately four hours last tuesday. No calls coming in were not answered for approximately four hours. Per ED, This has been corrected by the staff being in-serviced again on the phone procedure requirements. ED will submit proof of the in-service training by 4/13/21. This is a potential personal rights risk to residents in care.	8 9 10 11 12 13 14
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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: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20210407120351

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: VINEYARD AT FOUNTAINGROVE, THE	FACILITY NUMBER: 496803698
	VISIT DATE: 04/09/2021

NARRATIVE

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ED stated that he immediately addressed this and had the phone switched back to the front reception desk; ED stated it had been approximately four hours the phone line had not been switched back. ED stated he in-serviced training with the receptionist on the main phone line and the need to ensure the switch of the phone line back to the main line when coming on shift in the AM. The ED stated the receptionist had thought the phone line swiched on its own. ED stated the phone line incident that occurred has been corrected. Based on LPA interviews, and review of information obtained, the investigation has revealed that the allegation of staff are not answering the facility's main phone line, has been substantiated.

Due to the substantiation of the allegation, a citation, 87411 (a)(e), will be cited today-see LIC9099D.

The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Appeal Rights Given.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Dina Alviso	TELEPHONE: (707) 588-5082
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2021

LIC9099 (FAS) - (06/04)

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