502701602-7-14-2026-27-AS-LKIG-DW6TZC-20260720151006

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502701602
Report Date: 07/01/2026
Date Signed: 07/14/2026 02:17:04 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
05/05/2026 and conducted by Evaluator Charlie Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20260505103727

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:	11:30 AM
MET WITH:	Jose Ventura		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not provide appropriate care and supervision to resident

Staff did not treat resident with respect

Staff did not ensure resident PRN medication were given

Staff did not refill resident medications timely

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 that this facility employed (3) shifts for the AM, PM, and NOC hours throughout the day. It was learned that staffing consisted of facility caregivers who performed tasks of daily living for the residents in care. In addition, this facility also employed medication technicians who handled, dispensed, and documented all transactions involving the residents' medications which were centrally stored at this time.
Based on a review of the forms and documents gathered during the course of this investigation, it was learned that there were roughly 11 caregivers and 5 dedicated medication technicians on staff at this time

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-20260505103727

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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as supported by the LIC 500 that was completed and submitted into CCL on 03/16/2026.
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 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.
Based on interviews that were conducted during the course of this investigation, it was learned that facility residents felt safe in this environment. It was learned that facility residents felt safe enough to ask for help from the facility staff and would receive that assistance in a timely manner without any resentment or attitude from them.
Based on interviews that were conducted during the course of this investigation, it was learned that facility staff were expected to maintain a certain level of professionalism and carried themselves in that manner at all times when present at this facility.
It was learned that there were dementia residents and residents with a higher level of need which required staff to be more patient and understanding of these special circumstances. It was learned that staff were expected to always exercise patience and dedication at all times when dealing with these types of more difficult circumstances.

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