486803710-12-16-2025-21-AS-BMOS-DPLQYL-20251222113519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803710
Report Date: 12/16/2025
Date Signed: 12/16/2025 10:36:27 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
11/12/2025 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20251112101414

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: 80	DATE:	12/16/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Elizabeth Aguiar - Resident Service Director		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

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Facility staff are not maintaining the facility in a clean condition

INVESTIGATION FINDINGS:

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On 12/16/2025 Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to deliver findings of a complaint allegation received by Community Care Licensing on 11/12/2025. The allegation was that “Facility Staff are not maintaining the facility in a clean condition”

The department made observations, conducted interviews and reviewed records.
Interview with residents revealed that R3 felt that best part of living at Paramount was that it was, “clean, and the caregivers and residents are nice”, R3 revealed, that their impression of the housekeeping at Paramount was that “they were doing a great job”

When asked how the housekeeping is going at Paramount, R1 reported that, “They do not clean the blinds or dust and that one housekeeping can be moody, with mood swings from one day to the next and would state, “it’s not my job at times”
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025

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-20251112101414

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: 12/16/2025

NARRATIVE

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Continued from LIC9099C

R4 reported their impression of the housekeeping was, “fine”, while R2 reported that, “I think they are doing a good job”.

Interview with the Maintenance Director revealed that housekeepers are not allowed to pick up resident personal items to dust under, out of liability concerns for breaking resident personal items and that when they find a housekeeping skipping steps in their duties, they will write them up with an action plan.

Record review revealed that on 09/06/2024 and 07/30/2025 two separate “Employee Counseling Forms” were filled out by management for housekeepers deemed to be not fully performing their duties.

In addition, the Maintenance Director revealed that there is a process in place for residents to ask and attain special cleaning projects, like having their carpet steam cleaned or having carpet replaced.

An interview with a visiting RN that has made frequent visits to Paramount “over the years”, as well as other facilities in the Fairfield area revealed they thought “the cleanliness is above average and that staff are also very quick to respond to spills or odors.”

While LPA did obtain evidence of dusty window frames, dressers and television tables, none rose to the level of a requiring a citation at this time.

Because of conflicting information and interviews, the allegation that facility staff are not maintaining the facility in a clean condition is Unsubstantiated. A finding that the complaint is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

This report was reviewed with Elizabeth Aguiar-Resident Service Director whose signature confirms receipt.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025

LIC9099 (FAS) - (06/04)

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