507000307-7-23-2025-27-AS-KHOS-DK4NUB-20250731104605

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507000307
Report Date: 07/23/2025
Date Signed: 07/23/2025 11:19:00 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
06/25/2025 and conducted by Evaluator Ellen Lindstrom

COMPLAINT CONTROL NUMBER: 27-AS-20250625081543

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: 43	DATE:	07/23/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Joyes Prasad, Business Office Manager		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not safeguard resident's cash resources
Staff threatened resident

INVESTIGATION FINDINGS:

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On 7/23/25 Licensing Program Analyst (LPA) Triel Ellen Lindstrom went to the Vintage Faire Residential facility to deliver the findings on a complaint submitted on 6/25/2025.

Allegation: Staff did not safeguard resident's cash resources.
On 7/2/25 and 7/8/2025, Licensing Program Analyst (LPA) Lindstrom went to and toured the facility, reviewed documents, and interviewed staff and residents. During staff interviews, S2 stated that some residents keep money in a petty cash account at the facility that staff can use to purchase items that residents request once a week. S3 stated that residents make lists of items they want from the store and give it to S1, who goes shopping for residents once a week and then gives the residents their items along with a receipt. During resident interviews, R1 stated that residents can submit a shopping list every Tuesday.

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)

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Control Number 27-AS-20250625081543

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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R2 stated that S1 shops for residents once a week; R2 gives her a shopping list and S1 gets stuff at various stores. R3 stated that she gives them a list and staff shops once a week; she always gets what she wants.

The LPA inspected a binder that contained LIC 405 forms, Clients/Residents Safeguarded Cash Resources. Money spent by facility staff and the store that the purchase was made at was accurately documented.
Based on records reviewed and interviews conducted, the Department has concluded that the preponderance of the evidence has not been met to prove the allegation that staff did not safeguard resident’s cash resources. Therefore, the allegation of staff did not safeguard residents' cash resources is UNSUBSTANTIATED.

Allegation: Staff threatened residents.
On 7/2/25 and 7/8/25, Licensing Program Analyst (LPA) Triel Ellen Lindstrom went to and toured the facility, reviewed documents, and interviewed staff and residents. During resident interviews, R1 stated that she had been asked to transfer from her wheelchair to a dining room chair. She has not been threatened that if she does not comply, she will have to pay more money or be evicted. R3 stated that staff treated her well. During staff interviews, S1 stated that there are no pending evictions. S2 stated that she has never heard staff threaten a resident in any way.

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 threaten residents. Therefore, the allegation that staff threaten 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)

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