507000307-4-4-2022-27-AS-SDOB-CD7R44-20220405124056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 507000307
Report Date: 04/04/2022
Date Signed: 04/04/2022 03:42:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/30/2022 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 27-AS-20220330130835

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: 41	DATE:	04/04/2022
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Administrator , Prithika Singh		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not allow resident to have a private conversation on the phone.
Staff will not allow friend to visit with the resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Sarah Hurt conducted an unnanounced visit to the facility on April 4, 2022 at 2:45 p.m. to open a complaint on the allegations listed above. LPA met with facility Administrator Prithika Singh and explained the purpose for today's visit.

Regarding the allegation staff will not allow friend to visit with the resident. During the investigation it was discovered that the resident does not live at this facility locaton therefore, the allegation was deemed unfounded

Regarding the allegation staff do not allow resident to have a private conversation on the phone.During the investigation it was discovered that the resident does not live at this facility location therefore, the allegation was deemed unfounded

An exit interview was conducted with facility Administrator Prithika Singh and a copy of this report was left at the facility.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: (916) 879-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2022

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