486803806-7-29-2021-21-AS-KMOA-C5KN2K-20210804100448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 07/29/2021
Date Signed: 07/29/2021 11:15:52 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/11/2021 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20210611120748

FACILITY NAME:	VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE		FACILITY NUMBER:	486803806
ADMINISTRATOR:	HALL, JAMES		FACILITY TYPE:	740
ADDRESS:	3350 CHERRY HILLS COURT		TELEPHONE:	(707) 425-3588
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	250	CENSUS: 140	DATE:	07/29/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kayla Young		TIME COMPLETED:	11:30 PM

ALLEGATION(S):

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Resident's are locked in facility
Resident not treated with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint allegation. LPA met with Assistant Director Kayla Young and discussed the findings. This investigation has included four site visits; statements from witnesses and staff; review of pertinent documents. The following determinations have been made: Complainant alleges that on or about June 10, 2021, R1 was not able to access bedroom because of locked doors in stairway; On June 17, 2021, Fairfield Fire Inspector lll inspected the stairways and fire exits and determined "The building egress system (to be) compliant and operable.." No action was taken and no violations noted; Facility Administration published a memo to residents on June 02, 2021 explaining upgrade project for elevators with repair schedule and non operational times; Complainant alleges that R1 was yelled at and spoken to in a rude manner by facility staff on June 10, 2021; R1 states that they staff were disrespectful; Neither R1 or Complainant have identified the staff who are accused; no other witnesses are known to have been present. Although the allegations may be true, there is not a preponderance of evidence to prove the violations did or, did not , occur. Therefore, the allegations are UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/11/2021 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20210611120748

FACILITY NAME:	VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE		FACILITY NUMBER:	486803806
ADMINISTRATOR:	HALL, JAMES		FACILITY TYPE:	740
ADDRESS:	3350 CHERRY HILLS COURT		TELEPHONE:	(707) 425-3588
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	250	CENSUS: 140	DATE:	07/29/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kayla Young		TIME COMPLETED:	11:30 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint allegation. LPA met with Assistant Director Kayla Young and discussed the findings. This investigation has included four site visits; statements from witnesses and staff; review of pertinent documents. The following determinations have been made: During site visits conducted on July 07, 2021, the following was observed: Freezer door needing repair; towel stuffed in drain without a cover; broken grill containing old food particles; inoperable garbage disposal; dirty hot and cold wells. Based upon observations made during the site visit conducted on July 07. 2021, the preponderance of evidence standard has been met. Therefore, the allegations that the facility is in disrepair is SUBSTANTIATED.

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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-20210611120748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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, THE	FACILITY NUMBER: 486803806
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/02/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a) MAINTENANCE AND OPERATION.The facility shall be clean, safe, sanitary and in good repair at all times.. *** Based upon observations made at site visits, this requirement has not been met as evidence by: On or about July 07, 2021, the kitchen was observed to contain dirty cold and hot wells, grill with old food	1 2 3 4 5 6 7	Administrator to submit written plan to CCL by POC date in order to clear deficiency. Plan to address measures the facility will take to remedy the deficiencies noted in the kitchen. Plan due by POC date in order to clear the deficiency. Subject to re-inspection upon completion of the building remodel project.
	8 9 10 11 12 13 14	under grates, and inoperable and broken appliances. This posed an immediate risk to the health of the residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC9099 (FAS) - (06/04)

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