502701602-7-14-2026-27-AS-LKIG-DW6TYN-20260720150900

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701602
Report Date: 07/01/2026
Date Signed: 07/14/2026 01:21:18 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/06/2026 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260306164804

FACILITY NAME:	VINTAGE FAIRE RESIDENTIAL		FACILITY NUMBER:	502701602
ADMINISTRATOR:	SINGH, PRITHIKA BANDHANA		FACILITY TYPE:	740
ADDRESS:	3620-A DALE ROAD		TELEPHONE:	(209) 521-1798
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	49	CENSUS: 48	DATE:	07/01/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jose Ventura		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are mismanaging resident medication

INVESTIGATION FINDINGS:

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Unannounced complaint visit made out to this facility on 07/01/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Jose Ventura, who was interviewed at this time.
Current census was 48 residents.
The purpose of this visit was to deliver the findings from this investigation to this facility, and its representative, at this time.
Based on a review of the forms and documents gathered during the course of this investigation, it was learned for the month of February 2026 that a review of 25 resident Medication Administration Records (MARs) conducted revealed that all medications were properly administered and documented as such. From the 25 MARs reviewed, it was learned that only 4 of those residents requested for their PRN medications to be dispensed to them at that time.
It was learned that the PRN medications were available on hand to be dispensed as needed by the residents in care. It was learned that the primary medications which were prescribed to be dispensed on a daily basis

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

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 27-AS-20260306164804

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: VINTAGE FAIRE RESIDENTIAL	FACILITY NUMBER: 502701602
	VISIT DATE: 07/01/2026

NARRATIVE

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to the residents in care were available on site and dispensed properly with documentation to support that these tasks were completed.
It was learned that changes to the medications were properly noted and transferred into the E-MAR system that this facility employed at this time.
It was learned that changes or discontinuances to the resident medications were properly noted and transferred into the E-MAR system that this facility employed at this time.

As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.

There were no deficiencies observed or cited at this time.

Exit Interview

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2026

LIC9099 (FAS) - (06/04)

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