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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 08:20:57 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
12/20/2024 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20241220083914
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:
10:00 AM
MET WITH:Administrator Prithika Singh TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff are not ensuring residents take medication
Due to lack of supervision, residents are eloping
Staff do not ensure residents hygiene needs are met
Staff do not treat residents with respect/Dignity
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

Staff are not ensuring residents take medication- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on reviewed Certificate of Completion from Med Techs. Each Med Tech 11 hours of training including Side Effect Adverse Reaction, Medication Order And Working With Pharmacy and Understanding CA Medication Regulations. Staff interviewed stated that they have procedures on how to work with residents regarding medications. Residents interviewed stated that they take the medications that staff provide to them.
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 3
Control Number 27-AS-20241220083914
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, interviews with staff, and residents in care, on the information provided, it was unclear if staff are not ensuring residents take medication, therefore the allegation was deemed UNSUBSTANTIATED.

Due to lack of supervision, residents are eloping- LPA Lund reviewed facility records, and interviewed staff. Based on review of the facility elopement and missing resident procedures. Staff interviewed stated that do two-hour checks on residents in care and would notify management if resident eloped. Management stated that they would notify Modesto PD and CCL if a resident would elope.

Based on records reviewed, and interviews with staff, on the information provided, it was unclear if due to lack of supervision, residents are eloping, therefore the allegation was deemed UNSUBSTANTIATED.

Staff do not ensure residents hygiene needs are met- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on Morning & Evening shower reviewed. LPA interviewed residents in care stated that the take showers with the help with staff and on their own if they do not need the help of staff. Staff interviewed stated that they have schedule shower days for residents in care and will give a shower to a resident if needed.

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.

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 3
Control Number 27-AS-20241220083914
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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Staff do not treat residents with respect/Dignity- LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on staff training such as Understanding Alzheimers Disease, Abuse, Theft & Loss and Resident Rights. Staff interviewed stated that they have never witnessed any staff mistreating any resident in care, if so, would notify management immediately. Residents in care interviewed stated that they have never been mistreated by staff and never seen any other residents get mistreated.

Based on records reviewed, interviews with staff, and residents in care, on the information provided, it was unclear if staff do not treat residents with respect/Dignity, 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: 3 of 3