<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
496803698
Report Date:
02/04/2025
Date Signed:
02/04/2025 02:04:59 PM
Document Has Been Signed on
02/04/2025 02:04 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, THE
FACILITY NUMBER:
496803698
ADMINISTRATOR/
DIRECTOR:
SANDHU,RAJVIR
FACILITY TYPE:
740
ADDRESS:
200 FOUNTAINGROVE PKWY
TELEPHONE:
(707) 544-4909
CITY:
SANTA ROSA
STATE:
CA
ZIP CODE:
95403
CAPACITY:
64
CENSUS:
24
DATE:
02/04/2025
TYPE OF VISIT:
POC
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:
Denise Downey
TIME VISIT/
INSPECTION COMPLETED:
02:00 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
Licensing Program Analyst Leibert returns this date for POC visit. LPA has verified that the Administrator is now cleared and associated with the facility and that the front door is now operational. Heat in the resident room was previously cleared at a prior inspection. Deficiencies issued on visit date 01/07/2024 have been cleared and cleared POC letter issued.
SUPERVISORS NAME
:
Carla Martinez
LICENSING EVALUATOR NAME
:
David Leibert
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/04/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/04/2025
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