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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803806
Report Date: 05/15/2023
Date Signed: 05/15/2023 10:39:10 AM


Document Has Been Signed on 05/15/2023 10:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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, THEFACILITY NUMBER:
486803806
ADMINISTRATOR:LAUREN COTTMANFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:250CENSUS: 150DATE:
05/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Assistant Executive Director, Francine Taitano
Prospective Administrator, Augustin Samaniego		TIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Farhaan Sarangi conducted an unannounced Case Management-Other inspection at Village at Rancho Solano, The. LPA was greeted at the door by, Assistant Executive Director, Francine Taitano and Prospective Administrator, Augustin Samaniego, and was granted access into the facility. The purpose of this Case Management-Other inspection is to follow up on an Order of Immediate Exclusion letter issued on April 27, 2023.

During the Case Management-Other inspection, Assistant Executive Director confirmed Excluded Staff Member is not working in the facility or residing in the facility and has never worked at this facility. LPA obtained a copy of the Resident Roster, LIC 500 and the staff schedule. In addition, LPA and Assistant Executive Director toured the facility. Excluded Staff Member was not seen on the premises. Based on evidence obtained during today’s Case Management-Other Inspection, the LPA has verified Excluded Staff Member is not present, employed, or residing at the facility. Verification of removal is complete.

No deficiencies were observed or cited during today's Case Management-Other inspection. Exit interview was conducted and a copy of this report was given to the Assistant Executive Director.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5029
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: 707-588-5034
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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