486803806-4-28-2023-21-AS-CMAZ-CRGVYZ-20230503165158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 04/28/2023
Date Signed: 04/28/2023 10:49:20 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
04/10/2023 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 21-AS-20230410131207

FACILITY NAME:	VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE		FACILITY NUMBER:	486803806
ADMINISTRATOR:	LAUREN COTTMAN		FACILITY TYPE:	740
ADDRESS:	3350 CHERRY HILLS COURT		TELEPHONE:	(707) 425-3588
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	250	CENSUS: 167	DATE:	04/28/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Assistant Administrator, Lauren Cottman		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility staff ignored resident(s).
Facility staff did not meet resident's care needs
Facility staff did not provide toilet paper for resident.

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 the Receptionist, Maria Aispuro and was granted access into the facility. Assistant Administrator, Lauren Cottman arrived 15 minutes later.

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

Complaint alleges facility staff ignored resident(s) and facility staff did not meet resident’s care needs. Based on interviews and observations that were conducted during the investigation, LPA could not prove or disprove the allegation of staff ignoring residents in care. LPA toured the facility on April 11, 2023, and found residents doing activities with staff members. (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: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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-20230410131207

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: 04/28/2023

NARRATIVE

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LPA conducted another tour of the facility during the closure of the complaint on April 28, 2023 and found residents doing activities with staff members. Furthermore, on both said dates, the 1st and 2nd floor Memory Care Units were found to be clean, at a comfortable temperature with all exits free from obstruction.

Complaint alleges facility staff did not provide toilet paper for resident. Based on interviews that were conducted, LPA could not prove or disprove the allegation due to inconsistent statements made during the investigation. Furthermore, LPA conducted tours of the facility on April 11, 2023, and April 28, 2023, and observed toilet paper in all resident rooms.

A finding that the complaint allegations of Facility staff ignored resident(s), facility staff did not meet resident’s care needs and facility staff did not provide toilet paper for resident are unsubstantiated meaning that although the allegations 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: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

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