486803806-10-10-2024-21-AS-KMOA-DA5KWT-20241017081625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:04:44 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
09/11/2024 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20240911163325

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: 161	DATE:	10/10/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Morgan Whinery		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility is not meeting resident's care needs
Facility is charging resident for services not being given
Facility staff are not trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. During the course of this investigation statements were taken, documents reviewed and site visits made. The following determinations are made: Complainant alleges that facility is not meeting R1's care needs, staff are not trained in Hoyer lift and Body Mechanics, and that R1 is charged for services not provided; Resident Care Notes and shower logs indicate a pattern of refusal of care by R1; Facility has provided training records for staff on Hoyer lift and Body Mechanics; Neither Complainant nor R1 has identified any services that are charged but not provided in response to this Department's request for examples of services not provided but for which R1 is charged. Although the allegations may be true, or valid, there is not a preponderance of evidence to prove, or disprove, the allegations. Therefore, the allegations are UNSUBSTANTIATED.

Report left.

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: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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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