486803806-10-30-2023-21-AS-KMOA-CX6VKS-20231101163050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 10/30/2023
Date Signed: 10/30/2023 12:35:46 PM

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
09/26/2023 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20230926122904

FACILITY NAME:	VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE		FACILITY NUMBER:	486803806
ADMINISTRATOR:	AGUSTIN SAMANIEGO		FACILITY TYPE:	740
ADDRESS:	3350 CHERRY HILLS COURT		TELEPHONE:	(707) 425-3588
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	250	CENSUS: 140	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Francine Taitano		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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9

Personal Rights Violation

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. During the course of the investigation, witnesses were interviewed; site visits made; documents were obtained and reviewed. The following determinations are made: It has been alleged that unnamed staff spoke rudely to R1 while providing hygiene care to R1; Staff who routinely provide care for R1 deny the allegation; Family members report having been told by R1 of the rude behavior by staff; R1 has denied the allegation when interviewed in private by staff from this Department; No actual witnesses to the alleged behavior have been identified. Although the allegation may be true, based upon the statements and documents reviewed, there is not a preponderance of evidence to prove the allegation did or, did not, occur. therefore, the allegation is UNSUBSTANTIATED.

Report left.
No citations issued today.

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: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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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