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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507000307
Report Date: 04/17/2025
Date Signed: 04/18/2025 08:21:25 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
12/30/2024 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20241230145929
FACILITY NAME:VINTAGE FAIRE RESIDENTIALFACILITY NUMBER:
507000307
ADMINISTRATOR:PRITHIKA B SINGHFACILITY TYPE:
740
ADDRESS:3620-A DALE ROADTELEPHONE:
(209) 521-1798
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:49CENSUS: 41DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator Prithika SinghTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff are not properly addressing pest infestation

Facility staff do not provide adequate food service to residents

Licensee does not ensure sufficient number of staff on site to meet the
needs of clients in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Prithika Singh and explained the reason for the visit. Census: 41

Facility staff are not properly addressing pest infestation- LPA Lund reviewed facility records along with LPA’s observation of the facility, interviewed staff, and residents in care. Based on LPA Lund reviewed facility pest control records from Kingdom IPM Commercial & Residential Pest Control records. The facility records from 10/11/2024 through 4/11/2025 indicate that the facility was addressing any pest control problems. Staff interviewed stated that they have not observed any pest infestation. Resident interviewed stated they have not observed any pest infestation. During LPA’s visits on 12/26/24, 1/8/2025 and annual/one year required visit on 7/9/2024 the facility didn’t have any pest infestation.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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-20241230145929
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: 04/17/2025
NARRATIVE
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Based on facility records reviewed, LPA’s observation of the facility, interviews with staff, reporting party, and residents in care, on the information provided, it was unclear if facility staff are not properly addressing pest infestation, therefore the allegation was deemed UNSUBSTANTIATED.

Facility staff do not provide adequate food service to residents- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on review of the facility six-week menu rotation for the residents in care, reviewed Sysco food services from 10/2/2024 through 12/31/2024 and LPA’s Lund observation of 2- day supply of perishable food and 7- day supply of non-perishable food. Residents interviewed stated that they the facility is providing adequate food for them. Staff interviewed stated that residents have not complained about the food being served at the facility.

Based on records reviewed, interviews with staff, and residents in care, on the information provided, it was unclear if facility staff do not provide adequate food service to residents, therefore the allegation was deemed UNSUBSTANTIATED.

Licensee does not ensure sufficient number of staff on site to meet the needs of clients in care- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on staff schedule from 9/1/24 through 12/31/24 the revealed staff to be on duty consistently residents in care. LPA Lund interviewed residents in care who stated that their needs are being met. Staff interviewed stated that there is adequate staff to meet the needs of the residents in care.

Based on records reviewed, interviews with staff, and residents in care, on the information provided, it was unclear if licensee does not ensure sufficient number of staff on site to meet the needs of clients in care, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2