486803806-4-11-2023-21-AS-HDBI-CQTU8P-20230412152151

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 04/11/2023
Date Signed: 04/11/2023 09:48:57 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
03/01/2023 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 21-AS-20230301102827

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: 154	DATE:	04/11/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Assistant Executive Director, Francine Taitano		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Facility staff is not administering resident's medication as prescribed.
Facility does not have sufficient staff to meet residents' needs.

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. Also participating in the delivery of findings is Executive Director, Brittany Andrews from a sister community.

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.

Complaint alleges that Facility staff is not administering resident's medication as prescribed. During the course of the investigation, Facility records were reviewed, and LPA learned that the facility made attempts to refill the medication; however, the pharmacy was late on delivering the medication. On February 27, 2023, attempts were made on the facilities behalf to inquire on the medication that was not delivered. (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: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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-20230301102827

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: 04/11/2023

NARRATIVE

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On March 1, 2023, medication(s) were delivered, and proper dispensing was resumed on the medication that was awaiting to be refilled. Furthermore, LPA conducted interviews, LPA could not prove or disprove that the facility is not administering resident’s medication as prescribed.

Complaint alleges that facility does not have sufficient staff to meet residents’ needs. During the course of the investigation, facility records were reviewed which included the staff schedule. On April 4, 2023, LPA learned via observation of the staff schedule that the facility keeps the schedule up-to-date and that the schedule was completed in its entirety. In addition, during document reviews conducted on March 9, 2023, LPA reviewed the staff roster which was found to be appropriate during the review. LPA conducted interviews with residents. LPA could not prove or disprove that the facility does not have sufficient staff to meet resident’s needs.

A finding that the complaint allegations of Facility staff is not administering resident's medication as prescribed and facility does not have sufficient staff to meet residents’ needs 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 allegations are 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: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

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