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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 08/13/2024
Date Signed: 08/13/2024 12:41:15 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
08/02/2024 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20240802134502
FACILITY NAME:VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THEFACILITY NUMBER:
486803806
ADMINISTRATOR:AGUSTIN SAMANIEGOFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:250CENSUS: 124DATE:
08/13/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Morgan WhineryTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Licensee did not ensure that resident received medical attention in a timely manner.
Licensee did not ensure that staff followed infection control practices as necessary.
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. LPA met with the Administrator and discussed the disposition of this complaint. Complainant has alleged that a resident contracted a contagious infection and that staff were subsequently afflicted with the infection due to the facility's management not following accepted protocols to deal with the condition. This investigation has resulted in the following determinations: The Complainant has no direct knowledge of the allegations, was told of the allegations by a third party who has not been identified, and has not identified the resident or staff involved; The Administrator states that there has been no reported cases of infection that match the alleged one during the course of the last six months. Although the allegation may be true, or valid, based on the statements made, there is not a preponderance of evidence to prove or, disprove, the allegations. Therefore, the allegations are UNSUBSTANTIATED.
No citations issued today
Report left.
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: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
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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