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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 11/21/2024
Date Signed: 11/21/2024 12:18:56 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
10/03/2024 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20241003142003
FACILITY NAME:VINEYARD AT FOUNTAINGROVE, THEFACILITY NUMBER:
496803698
ADMINISTRATOR:ANTONETTE EDWARDSFACILITY TYPE:
740
ADDRESS:200 FOUNTAINGROVE PKWYTELEPHONE:
(707) 544-4909
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:64CENSUS: 33DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rajvir SandhuTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
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9
Facility does not have adequate staff to meet residents needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with ***** and discussed the disposition of the allegation that Facility does not have adequate staff to meet the residents' needs. Complainant is Anonymous without contact information and has alleged inadequate hydration for residents, lack of sufficient staff and products (assumed to be harmful) assessable to memory care residents. During the course of this investigation documents were reviewed and four unannounced site visits were made to facility. At each unannounced site visit, staffing was sufficient to meet the needs of the residents, hydration stations were observed available to the residents and no harmful products were observed to be accessible to the residents. Although the allegation may be true, or valid, based upon the documents, obsservations and statements, there is not a preponderance of evidence to prove, or disprove, the allegation. Therefore, the allegation is UNSUBSTANTIATED.
No citations issued today.
Report left.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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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