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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803806
Report Date: 04/11/2022
Date Signed: 04/11/2022 04:49:11 PM


Document Has Been Signed on 04/11/2022 04:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



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: 149DATE:
04/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Regional VP of Operations, Pamela Hardesty and Tommy SaxsonTIME COMPLETED:
05:00 PM
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Licensing Program Analysts Willis and Felias arrived unannounced to conduct a Case Management inspection and met with facility representatives, Pamela Hardesty and Tommy Saxson.

LPAs followed up regarding the status of the Change of Administrator. Per conversation, the facility will be submitting Change of Administrator paperwork for an interim Administrator.

LPAs also followed up regarding a self reported incident where a resident reported multiple items missing from their apartment. Facility was able to find many of the items in other apartments indicating that the apartments are in the memory care unit and they believe that the items were removed by other residents. Facility has agreed to reimburse the resident for any items that they are unable to locate. A police report was filed.

No deficiencies cited during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Victoria WillisTELEPHONE: (707) 588-5087
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2022
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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