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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 507000307
Report Date: 07/23/2025
Date Signed: 07/23/2025 11:10:10 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
05/08/2025 and conducted by Evaluator Ellen Lindstrom
COMPLAINT CONTROL NUMBER: 27-AS-20250508094937
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: 43DATE:
07/23/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Joyes Prasad, Business Officer ManagerTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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Staff do not provide resident with housekeeping service
Staff speak inappropriately to resident
INVESTIGATION FINDINGS:
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On 7/23/25 Licensing Program Analyst (LPA) Ellen Lindstrom went to the Vintage Faire Residential facility to deliver the findings on a complaint submitted on 5/08/25. The LPA met with the Business Officer Manager.

Allegation: Staff do not provide residents with housekeeping service.
On 7/2/25 and 7/8/2025, Licensing Program Analyst (LPA) Lindstrom went to the facility and toured the residential areas, walking up and down the hallways several times. She observed all bedrooms with open doors to be clean, organized, and free from malodors. Additionally, she entered and inspected seven resident bedrooms, which were also clean and malodor-free. During resident interviews, R1, R2 and R3 stated that staff cleaned their room every day. R4 stated that staff cleaned their room and made their bed daily. During staff interviews, S1 stated that rooms are cleaned every day and if there are incontinence issues, rooms are mopped more than once a day.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
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-20250508094937
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: 07/23/2025
NARRATIVE
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Based on observations made and interviews conducted, the Department has concluded that the preponderance of the evidence has not been met to prove the allegation that staff do not provide residents with housekeeping service. Therefore, the allegation that staff do not provide residents with housekeeping service is UNSUBSTANTIATED.

Allegation: Staff speak inappropriately to residents
On 7/2/2025 and 7/8/25, the Licensing Program Analyst (LPA) toured the facility, spoke to staff and interviewed residents. The LPA did not observe any staff speaking inappropriately to residents. During resident interviews, R1 stated that he feels very supported by staff, R3 stated that the caregivers are great, and R4 stated that staff treated her well. During staff interviews, S1 stated that she had not heard of any complaints recently.

Based on observations made and interviews conducted, the Department has concluded that the preponderance of the evidence has not been met to prove the allegation that staff speak inappropriately to residents. Therefore, the allegation that staff speak inappropriately to residents is UNSUBSTANTIATED.
There are no citations issued at this time.

Exit interview was conducted with the Business Office Manager. Appeal Rights were issued, and a copy of this report was left at the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Ellen Lindstrom
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2