496803825-10-11-2022-21-AS-CMAZ-CKMTB2-20221028143423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 496803825
Report Date: 10/11/2022
Date Signed: 10/11/2022 02:59:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
09/22/2022 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20220922095430

FACILITY NAME:	VINE RIDGE AT CLOVERDALE		FACILITY NUMBER:	496803825
ADMINISTRATOR:	LANHAM, RACHAEL		FACILITY TYPE:	740
ADDRESS:	247 TREADWAY DRIVE		TELEPHONE:	(707) 791-4787
CITY:	CLOVERDALE	STATE: CA	ZIP CODE:	95425
CAPACITY:	58	CENSUS: 26	DATE:	10/11/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Licensee, Larona Farnum and Administrator, Angie Smith		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Facility removed resident's personal belongings without consent
Facility did not allow entry to resident's visitor

INVESTIGATION FINDINGS:

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Licensing Program Analyst Bertozzi arrived unanounced to deliver findings regarding the above-mentioned allegations and met with Licensee, Larona Farnum and Administrator, Angie Smith.

Facility removed resident's personal belongings without consent – Complaint alleges that someone came into a resident’s room and stole items from their room without asking permission or allowing the resident to be present. Missing items were described as food and drinks from the resident’s refrigerator and from a shelf next to the refrigerator. Staff interviews indicate that staff came into a resident’s room after reports that the room was not safe and sanitary. Per interviews, multiple trays were observed with food that were moldy, so trays and food were removed by staff. Review of the facility’s Admission Agreement states that for the safety and comfort of the resident, staff must be permitted to enter an apartment to perform basic personal and housekeeping services, respond to emergencies and make repairs and improvements as the facility deems necessary or advisable. The agreement goes on to state that whenever feasible, facility staff will give reasonable notice for entering an apartment.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

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-20220922095430

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VINE RIDGE AT CLOVERDALE	FACILITY NUMBER: 496803825
	VISIT DATE: 10/11/2022

NARRATIVE

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Continued from LIC9099

Facility did not allow entry to resident's visitor – Complaint alleges that a resident’s friend was restricted from entering the facility. Per interview, Administrator indicated that they did have a conversation with a resident regarding a former employee coming to the facility but told the resident that they would have to gather more information to see if there was a policy that does not allow former employees to enter the facility. Administrator denied telling a resident that the individual could not come to the facility adding that the individual in question did not physically come to the facility so was not denied access.

A finding that the complaint allegations that facility removed resident's personal belongings without consent and facility did not allow entry to resident's visitor was unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegations occurred.

No deficiencies cited.

SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Victoria Bertozzi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

LIC9099 (FAS) - (06/04)

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