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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803698
Report Date: 12/09/2024
Date Signed: 12/09/2024 02:44:46 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
07/11/2024 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20240711134704
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: 29DATE:
12/09/2024
UNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Serina Barreda (Business Office Manager)TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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-Facility is overcharging resident in care.
-Staff does not communicate with responsible party in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra and support staff Ethel Contreras arrived unannounced for the purpose of delivering findings on this complaint and met with Serina Barreda, Business Office Manager. Complainant alleges multiple allegations that are noted above and referenced below in detail.

Facility is overcharging resident in care, Staff does not communicate with responsible party in a timely manner - Complaint alleges that resident’s responsible party made multiple attempts to contact the facility by telephone to notify them that the resident would not be returning to the facility following a hospital stay. Complainant was not able to provide proof that notification was sent in writing, After not receiving a response, the responsible party came to the facility and removed all of resident’s personal items. Two of two staff interviewed denied receiving a phone call or email prior to the move-out date. Review of Admission Agreement indicated that termination of the agreement requires a 30-Day written notice. CCL was unable to confirm that written notice was received by the facility prior to the day that personal items were removed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Marisol CuadraTELEPHONE: (707) 588-5078
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
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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