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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701602
Report Date: 07/21/2026
Date Signed: 07/22/2026 09:28:32 AM

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
07/17/2026 and conducted by Evaluator Charlie Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260717110513
FACILITY NAME:VINTAGE FAIRE RESIDENTIALFACILITY NUMBER:
502701602
ADMINISTRATOR:JOSE VENTURAFACILITY TYPE:
740
ADDRESS:3620-A DALE ROADTELEPHONE:
(209) 521-1798
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:49CENSUS: 48DATE:
07/21/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jose VenturaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not ensure the facility is clean and sanitary

Facility is malodorous
INVESTIGATION FINDINGS:
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Unannounced complaint visit made out to this facility on 07/21/2026 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Kulich who were met by the facility designated Administrator Jose Ventura. A brief interview was conducted with the facility designated Administrator at this time.
Current census was 48 residents.
The purpose of this complaint visit was to inform this facility, and it's representative, that a complaint had been filed with the above allegations at this time.
A brief tour of the facility was conducted. A review of the resident bedrooms was conducted. A review of the dining room and other areas designated for resident use was conducted.
A brief tour of the hallway and facility corridors was conducted. It was observed that new flooring was recently put into place in the hallways and common areas of this facility. It was observed that a facility notice was posted on the bulletin board next to the facility activities calendar informing all facility residents and staff that renovations were going to take place during the week ending 07/06/2026. These renovations involved the removal of the old carpet that lined the hallways and common areas that were going to be replaced
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 27-AS-20260717110513
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: 07/21/2026
NARRATIVE
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with new vinyl flooring.
It was learned that the posting of the construction project for the flooring was put up on 06/30/2026 with a commencement date of 07/06/2026.
Based on a review of the facility rooms and common areas it was observed by LPAs that the resident rooms were maintained in compliance to meet the needs of the residents at this time. In addition, it was observed that the common areas were maintained in compliance to meet the needs of the residents at this time as well. It was observed that there weren't any strong odors that would suggest that housekeeping and proper maintenance was not being upheld at this time.

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: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2