486803710-10-31-2025-21-AS-CMAZ-DN7VUQ-20251107154506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803710
Report Date: 10/31/2025
Date Signed: 10/31/2025 11:09:05 AM

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
07/29/2025 and conducted by Evaluator Ali Deniz

COMPLAINT CONTROL NUMBER: 21-AS-20250729090042

FACILITY NAME:	PARAMOUNT HOUSE SENIOR LIVING		FACILITY NUMBER:	486803710
ADMINISTRATOR:	SAMANIEGO,AGUSTIN		FACILITY TYPE:	740
ADDRESS:	2061 PEABODY RD		TELEPHONE:	(707) 455-0300
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	95	CENSUS: 82	DATE:	10/31/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Agustin Samaniego		TIME COMPLETED:	11:32 AM

ALLEGATION(S):

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Resident incontinence care needs not met.
Lack of supervision resulting in resident injury.
Personal Rights

INVESTIGATION FINDINGS:

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At approximately 09:30AM, Licensing Program Analyst (LPA) Deniz arrived unannounced to deliver findings for a Complaint Investigation regarding the above allegations and met with Administrator, Agustin Samaniego

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegations were investigated, “Resident incontinence care needs not met, lack of supervision resulting in resident injury, and personal rights.”

The complainant alleged that the resident’s incontinence care needs were not being met, particularly during the morning shift, resulting in the resident remaining soiled for extended periods. The complainant also alleged a lack of supervision, which reportedly led to a preventable fall and injury involving the resident. Furthermore, the complainant alleged that neglect and failure to provide adequate care and oversight constituted a violation of the resident’s personal rights, including the right to be treated with dignity and to receive safe, appropriate care.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

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 21-AS-20250729090042

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: PARAMOUNT HOUSE SENIOR LIVING	FACILITY NUMBER: 486803710
	VISIT DATE: 10/31/2025

NARRATIVE

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Continued from LIC9099 page...

LPA interviewed five (5) facility staff members, who indicated that incontinence care checks are conducted routinely, typically in the morning and at night, and every two (2) hours for hospice residents or residents identified as requiring more frequent care. S2 stated that some residents refuse incontinence checks, which are then documented and communicated to the next shift. Staff stated that progress notes are maintained for each resident to track care needs. Regarding the reported fall, staff reported that the incident occurred in the designated outdoor smoking area. S2 also stated that Resident R1 did not require one-on-one supervision at the time of the fall and that the resident reported attempting to reposition while seated, which resulted in the incident. Facility records confirmed that the resident was transported to the hospital for evaluation following the fall.
During the facility walkthrough, LPA observed Resident R1's room being cleaned by housekeeping staff. The room appeared clean and free of odors. The housekeeper interviewed stated that rooms are cleaned weekly and expressed no concerns regarding the provision of incontinence care by care staff.
LPA also conducted interviews with five (5) residents. All five (5) residents expressed general satisfaction with the care and services provided. Residents reported that staff assist with cleaning, laundry, and personal care as needed, and that rooms are kept clean. No residents reported concerns regarding incontinence care, supervision, or personal rights violations.
Based on information obtained through interviews, record reviews, and observations, there was insufficient evidence to support the allegations that the facility failed to meet incontinence care needs, that a lack of supervision resulted in a resident injury, or that resident personal rights were violated. Although the resident did experience a fall, the evidence did not show that the facility failed to provide appropriate supervision or care as required. Therefore, the allegations are UNSUBSTANTIATED. A finding that a complaint allegation is Unsubstantiated means that although the allegations may have occurred or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

Exit interview conducted. Copy of report discussed and provided to Executive Director. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

LIC9099 (FAS) - (06/04)

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