486803806-2-13-2023-21-AS-HDBI-CP625U-20230217160608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 02/13/2023
Date Signed: 02/13/2023 12:34:04 PM

Substantiated

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
01/30/2023 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 21-AS-20230130105428

FACILITY NAME:	VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE		FACILITY NUMBER:	486803806
ADMINISTRATOR:	RAMANDEEP KAUR		FACILITY TYPE:	740
ADDRESS:	3350 CHERRY HILLS COURT		TELEPHONE:	(707) 425-3588
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	250	CENSUS: 150	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Assistant Executive Director, Francine Taitano		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not respond to resident's call for assistance in a timely manner
Staff are not adequately trained to meet the needs of residents in care
Staff do not answer the facility after hours phone line

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Village at Rancho Solano, The for the purpose of delivering complaint findings. LPA was greeted at the door by Assistant Executive Director, Francine Taitano, and was granted access into the facility.

During the course of the investigation, LPA Sarangi reviewed resident(s) records, staff records, facility records, interviewed staff, residents and various outside parties, including but not limited to responsible parties and witnesses. During the review of resident records on February 9, 2023, LPA observed and identified that Resident #4 was last reappraised on July 2021 (See LIC 9102-Technical Violation).

(Report continued on LIC 9099C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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 6

Control Number 21-AS-20230130105428

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: 02/13/2023

NARRATIVE

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Complaint alleges that Staff do not respond to resident's call for assistance in a timely manner. Based on interviews that were conducted with staff, LPA learned that Resident #1 does wear a Call Pendant. During the opening of the complaint on January 31, 2023, the previous Administrator denied that Memory Care residents wear a call pendent. However, LPA observed Resident #1 wearing a Call Pendant. (See LIC 812, interview dated for January 31, 2023, titled: Interview-Administrator) Furthermore, LPA reviewed resident records which included the Call Pendant log for Resident #1 from January 20, 2023 through January 23, 2023 and learned that Resident #1 had eight instances of response times lasting more than 20 minutes and an average response time of 2 hours and 27 minutes with some instances lasting hours (See LIC 9099D). Previous Administrator disclosed to the LPA that there was no history of Call Pendant Logs for December 2022 for Resident #1.

Complaint alleges that Staff are not adequately trained to meet the needs of residents in care. LPA reviewed facility records which included the staff training records, interviewed staff and residents in care. In addition, on February 6, 2023 during a subsequent complaint investigation inspection, LPA reviewed staff training records with the Regional Vice President and Assistant Executive Director and learned that 10 staff members including the former Administrator did not have the proper training hours necessary (See LIC 9099D).

Complaint alleges that Staff do not answer the facility after hours phone line. During the opening complaint on January 31, 2023, LPA requested the after hours call history for the phone that is designated as the after-hours phone line. LPA reviewed those records at the facility and learned that on January 20, 2023 and January 24, 2023 phone calls were missed and not returned back in a timely fashion. In addition, on February 06, 2023, during a subsequent complaint investigation inspection, LPA and Regional Vice President reviewed the call history log for the after-hours phone together, LPA showed the said dates (January 20, 2023 and January 24, 2023) to the Regional Vice President and the missed calls associated to those dates (See LIC 9099D).

Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the deficiency and/or repeated deficiencies within a 12 month period may result in civil penalties. Exit interview was conducted with the Administrator and appeal rights were given along with this report.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 21-AS-20230130105428

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/14/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements – General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…	1 2 3 4 5 6 7	Licensee to submit a self-certification along with staff training regarding facility call pendants by POC due date of 02/20/2023.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on records reviewed and interviews conducted, facility staff were unable to respond to resident care needs and call buttons in a timely manner from January 20 through January 23, 2023. Records reviewed indicated that multiple call buttons had response times of 20 minutes or longer. In addition, December 2022 Call Pendants were not available for viewing. This poses an immediate risk to the health and safety of residents in care.	8 9 10 11 12 13 14	In addition, facility shall also submit a statement on how future compliance will be met.
Type B 02/20/2023 Section Cited CCR 87707(a)(1)((a)(2)	1 2 3 4 5 6 7	87707(a)(1) & 87707((a)(2) Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments:	1 2 3 4 5 6 7	Licensee/Regional Vice President shall ensure that ALL staff are trained in accordance with Title 22 regulations. In addition, a written statement on how future compliance and training shall be submitted on February 20, 2023.
	8 9 10 11 12 13 14	(a) Licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall ensure that all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia, meet the following training requirements: (1) Direct care staff shall complete six hours of orientation specific to the care of residents with dementia within the first four weeks of working in the facility. (2) Direct care staff shall complete at least eight hours of in-service training on the subject of serving residents with dementia within 12 months of working in the facility and in each succeeding 12-month period. Direct care staff hired as of July 3, 2004 shall complete the eight hours of in-service training within 12 months of that date and in each succeeding 12-month period. This requirement was not met as evidenced by: Based off of facility records review on February 6, 2023 with the Regional Vice President, LPA and Regional Vice President identified 10 staff members including the former Administrator who did not have the sufficient number of hours as outlined in Title 22 regulation. This poses a potential Health, Safety and Personal Rights risk to the residents in care.	8 9 10 11 12 13 14	All staff trainings shall be conducted, and proof of those trainings shall be furnished to the Department by February 20, 2023.

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: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 21-AS-20230130105428

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/14/2023 Section Cited CCR 87468.1(a)(9)	1 2 3 4 5 6 7	87468.1(a)(9) Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately.	1 2 3 4 5 6 7	Licensee/Regional Vice President shall ensure that ALL telephones owned by the facility shall be responded to and answered in a timely manner.
	8 9 10 11 12 13 14	Based off of facility records review which included the After-Hours phone history on February 6, 2023 with the Regional Vice President, LPA and Regional Vice President identified on January 20, 2023 and January 24, 2023 phone calls were missed and not returned back in a timely fashion. This poses an immediate Health, Safety and Personal Rights risk to the residents in care.	8 9 10 11 12 13 14	In addition, a written statement on how future compliance and training shall be submitted on February 20, 2023.
	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: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 6

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
01/30/2023 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 21-AS-20230130105428

FACILITY NAME:	VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE		FACILITY NUMBER:	486803806
ADMINISTRATOR:	RAMANDEEP KAUR		FACILITY TYPE:	740
ADDRESS:	3350 CHERRY HILLS COURT		TELEPHONE:	(707) 425-3588
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	250	CENSUS: 150	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Assistant Executive Director, Francine Taitano		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not ensure residents hygiene needs are met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Village at Rancho Solano, The for the purpose of delivering complaint findings. LPA was greeted at the door by Assistant Executive Director, Francine Taitano, and was granted access into the facility.

During the course of the investigation, LPA Sarangi reviewed resident(s) records, staff records, interviewed staff, residents and various outside parties, including but not limited to responsible parties and witnesses.

Complaint alleges that Staff do not ensure residents hygiene needs are met. LPA reviewed resident records which included the Care Plan, interviewed staff and residents in care. Based on interviews that were conducted and a review of resident records, LPA could not prove or disprove that Staff do not ensure residents hygiene needs are met due to inconsistent statements made to the LPA during the course of the

(Report continued on LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 21-AS-20230130105428

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: 02/13/2023

NARRATIVE

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A finding that the complaint allegation of Staff do not ensure residents hygiene needs are met is 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. Exit interview was conducted and a copy of this was report was signed and given to the Assistant Administrator.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan Sarangi	TELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 6