<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496804113
Report Date: 08/19/2025
Date Signed: 08/19/2025 04:57:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2025 and conducted by Evaluator Dina Alviso
COMPLAINT CONTROL NUMBER: 21-AS-20250814081323
FACILITY NAME:FOUNTAINGROVE LODGEFACILITY NUMBER:
496804113
ADMINISTRATOR:LEONE, MEGAN E.FACILITY TYPE:
741
ADDRESS:4210 THOMAS LAKE HARRIS DRIVETELEPHONE:
(707) 576-1101
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:173CENSUS: DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Megan Leone-AdministratorTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not preventing the spread of a communicable disease.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alviso conducted a complaint inspection, on 8/19/25 at approximately 9:45am, and met with Administrator Megan Leone.

Reporting party alleges that “facility staff are not preventing the spread of a communicable disease”.

LPA reviewed eight (8) resident records, progress notes, and medical records/medication orders. LPA interviewed staff, S1, S2, S3, and S4, regarding resident care, the allegation of a current contagious disease outbreak, and facility infection control procedures.

The investigation revealed that residents' records reviewed identified that none of the eight (8) residents have scabies and/or bed bug bites. Caregivers/staff have all personal protective equipment (PPE) supplies available for use to them if needed, per infection control plan and job duties.

Continued on LIC9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
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 21-AS-20250814081323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: FOUNTAINGROVE LODGE
FACILITY NUMBER: 496804113
VISIT DATE: 08/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
There have been staff, S3, S4, S5, and S6, that were tested by their own Doctor's for scabies and/or other contagious disease; Staff have notified Administration staff of medical visits, and that they were not infected with scabies and/or other contagious disease. The facility had an inspection conducted by a professional company, Eco Lab, on 8/15/25, which found no scabies and/or bed bug outbreak in the memory care building.

There was differing information obtained from what was reported. There was no information obtained in the investigation to support a violation had occurred.

Based on LPA interviews, record/document reviews, and related information obtained during the investigation, the allegation is Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies cited.
Exit interview conducted with Administrator Megan Leone.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2