507000307-5-6-2024-27-AS-LRIS-D5QVT9-20240529164242

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507000307
Report Date: 05/06/2024
Date Signed: 05/06/2024 05:03:48 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
02/26/2024 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20240226113502

FACILITY NAME:	VINTAGE FAIRE RESIDENTIAL		FACILITY NUMBER:	507000307
ADMINISTRATOR:	PRITHIKA B SINGH		FACILITY TYPE:	740
ADDRESS:	3620-A DALE ROAD		TELEPHONE:	(209) 521-1798
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	49	CENSUS: 34	DATE:	05/06/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Joyce Prasad		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff caused injuries to residents while in care
Staff do not meet the residents hygiene needs
Staff are not addressing the resident dental needs
Staff are unable to communicate effectively with the residents
Staff allow the residents to have access to fumigated rooms
Staff yell at the residents

INVESTIGATION FINDINGS:

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On 5/6/24 at approximately 9:50 am, Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to continue a complaint investigation in to the above listed allegations. LPA Jensen met with business office manager, Joyce Prasad and explained the purpose of today's visit.

During the course fhe investigation, LPA Jensen reviewed facility records, resident records, made site observations and interviewed residents, staff, responsible parties and outside medical providers.

Allegation 1: Staff caused injuries to residents while in care
LPA Jensen interviewed a total of 9 staff members, 1 hospice nurse, 1 family member of a resident and 10 residents. All deny having ever witnessed or expienced staff causing injuries to a resident. 10 of 10 residents interviewed stated they are treated well by staff. Based on the interviews conducted the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

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 4

Control Number 27-AS-20240226113502

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: 507000307
	VISIT DATE: 05/06/2024

NARRATIVE

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Allegation 2: Staff do not meet the residents hygiene needs
LPA Jensen observed residents at the facility on 6 separate occasions over the course of the past 4 months. LPA Jensen did not observe any residents that appeared to have their hygiene needs neglected. In addition, LPA Jensen interviewed 10 residents who state they handle their own hygiene needs or state that they have never had a problem getting staff to assist with hygiene needs. A resident family member that was interviewed and a hospice nurse that was interviewed both denied having any concerns regarding resident hygiene therefore the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Allegation 3: Staff are not addressing the resident dental needs
LPA Jensen interviewed 10 residents and 1 family member of a resident. All state that staff would assist them if they had any dental needs or that they would solicit the help of family members if they needed to be taken to appointments. LPA Jensen interviewed staff that state they would assist with transportation or make arrangements for dental care when and if needed. Based on the interviews conducted the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Allegation 4: Staff are unable to communicate effectively with the residents
LPA Jensen interviewed 10 residents and 1 family member of a resident. All state they have never had a problem communicating with staff. During the last 4 months, LPA Jensen has visited the facility 6 times and never encountered a staff member that she was unable to communicate with therefore the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Allegation 5: Staff allow the residents to have access to fumigated rooms
LPA Jensen conducted an interview with the Administrator Prithika Singh. She advised that pest control treatments were done which required the residents to leave the room for several hours. The facility made arrangements with the pest control company to fumigate in the morning as soon as the residents were taken out of there room for breakfast. The facility then initiated several activities for resident engagement to keep the residents out of their rooms until it was safe to return. LPA Jensen interviewed 10 residents who all deny being given access to fumigated rooms. Based on the interviews conducted the allegation UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20240226113502

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: 507000307
	VISIT DATE: 05/06/2024

NARRATIVE

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Allegation 6: Staff yell at the residents
LPA Jensen interviewed a total of 9 staff members, 1 hospice nurse, 1 family member of a resident and 10 residents. All deny having ever witnessed or experienced staff yelling at a resident. 10 of 10 residents interviewed stated they are treated well by staff. Based on the interviews conducted the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

An exit interview was conducted and a copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja Jensen	TELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024

LIC9099 (FAS) - (06/04)

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