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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 08/23/2021
Date Signed: 08/23/2021 11:40:39 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2021 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20210622171315
FACILITY NAME:VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THEFACILITY NUMBER:
486803806
ADMINISTRATOR:HALL, JAMESFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:250CENSUS: 145DATE:
08/23/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Noma MalikTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility has a foul odor.
Staff not properly preparing food.
Residents are not served food in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Noma Malik and discussed the allegations. Complainant alleges that the facility has a foul odor in the kitchen and that the food served to residents is not properly prepared and not served timely. During the course of this investigation five unannounced site visits were made which included inspecting the kitchen and dining areas, as well as resident bedrooms and common areas; interviewing staff and residents; observing and sampling food preparations; obtaining and reviewing documents. The following determinations have been made: No foul odors in the kitchen or other areas at the time of site visits; site visits conducted when food was being prepared by staff did not produce any visible violations of Title Twenty-Two regulations; Residents have varying opinions on timeliness of food service; Covid precautions slowed food service due to tray meals operation. While the allegations may be true, or valid, based upon the interviews and observations, there is not a preponderance of evidence to prove the violations did, or did not, occur. Therefore, the allegations are UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2021 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20210622171315

FACILITY NAME:VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THEFACILITY NUMBER:
486803806
ADMINISTRATOR:HALL, JAMESFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:250CENSUS: 145DATE:
08/23/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Noma MalikTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility has an insect infestation
Facility is in disrepair
Food is not labeled
Floor and food storage areas are not clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering finding on the above captioned complaint allegations. LPA meet with Noma Malik and discussed the allegations. This investigation included five unannounced site visit which included inspecting kitchen, dining area as well as common areas and resident rooms; records were reviewed and statements taken. The following determinations were made: Administration and staff state there has been roach and rodent infestations in kitchen; LPA observed food storage area and holding carts in dirty condition and open food stored without dates or labels; LPA observed inoperable garbage disposal, freezer door needing repair, broken and dirty grill. Based upon observation and statements, the preponderance of proof standard has been met. Therefore, the allegations are SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20210622171315
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE
FACILITY NUMBER: 486803806
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2021
Section Cited
CCR
87555(b)(27)
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87555(b)(27) General Food Service Requirements. All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. ***Based upon observations, this requirement has not been met as evidenced by: LPA observed kitchen floor; food storage areas and carts in a dirty state. This posed an immediate risk to the health of the residents in care.
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Cleared at time of visit. Subsequent visits show that kitchen has been cleaned and areas previously noted met regulation.


Type B
09/06/2021
Section Cited
CCR
87555(b)(9)
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87555(b)(9) General Food Service Requirements… Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.***Based upon observations, this requirement not
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Administration to train all staff handling food in the requirements of 87555 and will provide proof of training by POC date in order to clear the deficiency.

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met as evidenced by: opened food observed stored without labels or dates. This posed an immediate risk to the health of the residents in care.
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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: Carla MartinezTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David LeibertTELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3