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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803806
Report Date: 12/10/2024
Date Signed: 12/10/2024 12:46:47 PM

Document Has Been Signed on 12/10/2024 12:46 PM - 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/
DIRECTOR:		WHINERY,MORGANFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY: 250CENSUS: 179DATE:
12/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ieshaa RaglandTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst Leibert arrived unannounced for the purpose of following up on an incident reported by facility on 11/06/2024. The spouse of a resident (R1) had alerted staff to a possible infection. Staff arrived, assessed R1 and indicated 911 should be called. The spouse objected but the med tech who was present called 911 and R1 was taken to a medical facility. R1 has not returned to the facility and has been transferred to skilled nursing from the original medical facility. If and when R1 returns to the facility staff will provide observation to insure proper healing.

No citations issued today.
Report left.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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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