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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803806
Report Date: 10/27/2021
Date Signed: 10/27/2021 04:07:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THEFACILITY NUMBER:
486803806
ADMINISTRATOR:MALIK, NOMAFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:250CENSUS: DATE:
10/27/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Kayla Young, Assistant Executive Director; Meri Vejar, Regional Director of Health and Wellness, and Kelli Roe, Operations CoordinatorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Jill Nakagawa met with Kayla Young, Assistant Executive Director, Meri Vejar, Regional Director of Health and Wellness, and Kelli Roe, Operations Coordinator, for a case management.

Facility self reported on 10/08/2021 that R1 reported money stolen from room. R1 believes the money was taken from drawer sometime between 10/02 and 10/04, and an amount between $1000 and $1700. R1 is independent and staff do not regularly enter apartment. Police Department and Ombudsman's Office were notified by Blaine Lyons, Op Specialist with the facility. In response to the loss Facility held a Town Hall Meeting on 10/14/2021 to caution residents about theft and loss and offered to purchase and install lock boxes for any residents who wanted them. Facility's theft and loss policy was also reviewed at that time.

LPA requested documentation:
Theft and Loss Policy
Town Hall Meeting Notes
Fairfield Police Report (so far no response to facility regarding case #):
Investigations: (707)428-7600


No citations for deficiencies issued at this time
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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