486803806-9-16-2022-21-AS-BMOS-CJNSYU-20220927141806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 09/16/2022
Date Signed: 09/16/2022 10:19:30 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/17/2022 and conducted by Evaluator Carla Fernandes-Goes

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220217094331

FACILITY NAME:	VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE		FACILITY NUMBER:	486803806
ADMINISTRATOR:	MALIK, NOMA		FACILITY TYPE:	740
ADDRESS:	3350 CHERRY HILLS COURT		TELEPHONE:	(707) 425-3588
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	250	CENSUS: 156	DATE:	09/16/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Blaine Lyons - Acting Executive Director		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff left residents unattended
Staff did not respond to call bell

INVESTIGATION FINDINGS:

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The Department conducted a complaint investigation regarding the allegation listed above. Licensing Program Analyst Fernandes-Goes arrived unannounced for the purpose of closing the investigation and met with Blaine Lyons - Acting ED.

On 2/24/2022, LPA Willis opened the complaint investigation. Department conducted a follow up visit on 4/11 and 8/11/2022 to tour the facility; conducted interviews; acquired documentation; and made observations of the facility. During documentation review on file, observations, and interviews of staff, residents, and complainant on ,2/24, 4/11, 5/20, 8/11, and 8/25/2022 Department learned that facility alarm system staff responded to call bell but not timely. According to records on 2/17/2022 from 100 % of calls 22 % were answered in a time frame of 10 to 29 min and 9.6 % of calls took 30 min to 1 hr 18 min to be answered. (copy of records on file) - Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

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-20220217094331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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, THE	FACILITY NUMBER: 486803806
	VISIT DATE: 09/16/2022

NARRATIVE

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Even though records show that call bell alarms in Assisted Living were not answered in a timely matter to ensure that residents' needs were meet (see Case Management report for 9/16/2022), there is not enough to prove or disprove that facility staff failed to respond to call bell.

In regard to “staff left residents unattended”, Department learned during interviews and documentation cited above that there were only one staff in assisted living after the hours of 4:09 AM. Department obtained an email from Acting ED Jillian Hunter on 2/25/2022 stating that there were 1 medication technician and 3 caregiver on schedule for 2/17/2022. Facility was not able to provide a formal schedule. Complaint stated that resident had a fall and contacted family member for assistance after pressing call bell alarm and not receiving any staff assistance. Family members called facility – no answer, family member arrived at facility through unlock front door and found no staff after looking around for 20 minutes, helped resident and left without seen a staff around. Resident after being assisted by family was attended by staff – records show that there was a wait of 49 min and that staff stated to resident that “’staff’ was by ‘itself’”. Resident was left without assistance for a long period of time and Department is not able to prove or disprove that residents were left unattended. (copy of records on file)

A finding that the complaint allegations of “Staff left residents unattended” and “Staff did not respond to call bell.” are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during this inspection.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Carla Fernandes-Goes	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022

LIC9099 (FAS) - (06/04)

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