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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803710
Report Date: 10/21/2025
Date Signed: 10/21/2025 10:48:12 AM

Substantiated


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
08/27/2025 and conducted by Evaluator Star Stevenson
COMPLAINT CONTROL NUMBER: 21-AS-20250827152145
FACILITY NAME:PARAMOUNT HOUSE SENIOR LIVINGFACILITY NUMBER:
486803710
ADMINISTRATOR:SAMANIEGO,AGUSTINFACILITY TYPE:
740
ADDRESS:2061 PEABODY RDTELEPHONE:
(707) 455-0300
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:95CENSUS: 82DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH: Executive Director Agustin Samaniego TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff do not answer resident call buttons in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stevenson arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Executive Director Agustin Samaniego.
During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations.

Licensing Program Analyst (LPA) Star Stevenson conducted nine (9) staff interviews and seven (7) resident interviews. Compliant alleges that two (2) caregivers are known to hide in rooms together or to eat in the break room while not answering call lights or will answer a call light, mention they need to return to do the actual care requested and then not return to perform the care. Staff member S1 also reports that staff member S3 will turn a call light off, as if it has been answered, but not provide the care at the time of turning the call light off and not return to provide the requested care. Staff member S3 reports that both staff members S1 and S2 will also avoid answering call lights, all together. Staff member S5 reports knowing that staff members S3 and S7 will turn a call light off, offer to provide care and then not return to provide the needed care. In addition, LPA was told by staff person S5, that the facility has tried to keep call light response times down to 15 minutes and are focused on answering call lights in 12 minutes or faster with a goal of 7-minute response time.

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 5
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
08/27/2025 and conducted by Evaluator Star Stevenson
COMPLAINT CONTROL NUMBER: 21-AS-20250827152145

FACILITY NAME:PARAMOUNT HOUSE SENIOR LIVINGFACILITY NUMBER:
486803710
ADMINISTRATOR:SAMANIEGO,AGUSTINFACILITY TYPE:
740
ADDRESS:2061 PEABODY RDTELEPHONE:
(707) 455-0300
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:95CENSUS: 82DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Executive Director Agustin SamaniegoTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff do not meet residents care needs.
Staff do not treat residents with dignity and respect
Insufficient Staffing
INVESTIGATION FINDINGS:
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***This is an amended report to update the findings of investigation of the allegations above***
In addition, Community Care Licensing (CCL) received an allegation of facility staff not meeting residents’ care needs and not treating residents with dignity and respect. Licensing Program Analyst (LPA) Star Stevenson conducted nine (9) staff interviews and seven (7) resident interviews. Residents R1, R2, R3, R6, R7, R8 and R9 expressed that the help they receive from staff is good and that the help is dignified. Residents R1 and R3 report not having to wait, to have a wet incontinence briefs changed and R6 reports “not hearing of people having to wait to have wet clothes changed”. Resident R9 reports, “the help is great”, “no concerns” and that “the caregivers are very friendly”. R3 reports, “the care is good”. Resident R7 reports, “the staff that do come to work are good”
During interviews with both staff and residents, LPA learned that shower refusals are common among a number of residents, and the facility has a policy to keep trying either in the next shift or by having another “face” or staff member try to help a resident to improve compliance with showers. Because of resident interviews and LPAs, on-site observations including a lack of odors, and record review, the allegations of staff not meeting resident’s care needs and not treating residents with dignity and respect 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 occur.
Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 21-AS-20250827152145
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: 10/21/2025
NARRATIVE
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Continued from LIC9099-A

Additionally, CCL received an allegation of insufficient staffing. Facility is licensed for 95 residents, 5 of which can be bedridden, with a hospice waiver for 10 residents. Interviews and document review with staff members S5 and S3 revealed that fifteen (15) residents in both assisted living and memory care require two-person assistance from hands-on caregivers for care and transfers. In conducting staff and resident interviews, LPA learned that earlier this year, staffing was particularly low with both management and staff indicating, several new employees had started work and then found the job or the hours, too challenging and quit suddenly. In addition, LPA learned that frequent call-offs on the weekend were and are common. It is noted that on 05/16/2025 Community Care Licensing (CCL) issued a REPEAT citation and civil penalty for insufficient staffing 87411(a) which requires, “Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs”

Staff member S3 alleged that just two (2) caregivers were working in April, May and June of 2025, while just three (3) caregivers were working in July and August of 2025. S3 also alleged that staffing was particularly low on 09/03/2025 and 09/07/2025. LPA reviewed payroll records from 09/01-09/15/2025. LPA learned that in fact, the lowest staffing on 09/03/2025 was the PM shift that had seven (7) direct caregivers on staff including Med-techs. On 09/07/2025 the AM shift saw the lowest staffing with five (5) direct caregivers working, including at least one (1) Med-Tech. In addition, LPA learned that various staff members volunteer to come in to cover extra shifts when others call off suddenly. Finally, residents’ reports, “Paramount has enough staff” and staff member S1 reports, “in the past we did not have enough staff, but in the last month staffing has improved, noting that they and two other staff members also pick up extra shifts. Staff member S2 reports picking up extra shifts and that, “when everyone comes in it is amazing” Staff member S4 reports, “my supervisor has been trying to hire, but people will start and say the work is too hard and quit” Because of inconsistent reports about the appropriateness of current staffing levels, and because of consistent reports that care needs are being met, the allegation 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 Executive Director Agustin Samaniego.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20250827152145
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: 10/21/2025
NARRATIVE
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Continued from LIC9099

Staff member S1 reports, “no call light gets answered slower than 15 minutes” and staff member S2 reports that, “management would like us to answer call lights within 7 minutes. Resident R3 reports, “call lights are answered within 15 minutes” During the course of record review, LPA learned that the average call light response time from 09/03/2025 to 09/07/2025 was 20 minutes over 756 calls for help. In addition, from 08/23/2025 to 08/26/2025 the average call light response time was 14 minutes over 585 calls for help and finally on 09/09/2025 the average call light response time was 12 minutes over 87 calls for help. Because of the longer call light response times and because of consistent reports from both staff and residents, that even when call lights are answered, help is often delayed or not given at all, the allegation is Substantiated. A finding that the complaint is substantiated means there is a preponderance of evidence to prove the alleged violations did occur.

A repeat deficiency and civil penalty in the amount of $250 is being issued for violation of California Code of Regulations (CCR) 87411(a), which was also cited on 05/15/2025 and requires, “Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs”

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with XXXX and Appeal rights were given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20250827152145
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/22/2025
Section Cited
CCR
87411(a)
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87411(a) Facility Personal shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs:
This requirement was not met as evidenced by:
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Licensee to submit self-certification to CCL stating that all care staff will be coached on the facility's call light response requirements, as well as how staff will respond in instances of lower staffing and/or staff call offs.

****Civil Penaliteis of $XXX for repeat violation.
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Based on interviews of both staff and residents, as well as record review, revealed instances of call lights being answered and turned off with care being delayed or not provided at all, as well as, the average call light response time from 09/03/2025 to 09/07/2025 being 20 minutes over 756 calls for help
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5