486804297-4-20-2026-21-AS-BMOS-DTJUY8-20260427155931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804297
Report Date: 04/20/2026
Date Signed: 04/20/2026 10:07:52 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
04/01/2026 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20260401163236

FACILITY NAME:	VACAVILLE VILLAGE SENIOR LIVING		FACILITY NUMBER:	486804297
ADMINISTRATOR:	SAMANIEGO, AGUSTIN		FACILITY TYPE:	740
ADDRESS:	2061 PEABODY RD		TELEPHONE:	(323) 902-6000
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	160	CENSUS: 76	DATE:	04/20/2026
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Agustin Samaniego-Administrator		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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personal rights

INVESTIGATION FINDINGS:

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At approximately 09:45 AM Licensing Program Analyst (LPA) Stevenson arrived unannounced to deliver complaint findings for a complaint received by the department on 04/01/2026 in which it was alleged that a personal rights violation occurred in which the personal privacy of a Resident of Vacaville Village had been violated.

The complaint alleged that a, “serious concern regarding Resident privacy at Vacaville Village Assisted living” had occurred and that on “March 31, 2026, a photo was posted on a staff member’s personal Facebook page that appears to show a Resident, with a staff member visibly wearing a company (Vacaville Village Senior Living) name tag, which directly associates the post to the facility”

Record review by Community Care Licensing (CCL) revealed that Resident (R1) had moved out on in May of 2025 and an interview with staff member (S1) revealed that the photo in question was taken by the family (W1) at the private residence of R1 in late November or early December 2025 and that R1 was no longer a Resident of Vacaville Village Senior Living

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

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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Control Number 21-AS-20260401163236

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VACAVILLE VILLAGE SENIOR LIVING	FACILITY NUMBER: 486804297
	VISIT DATE: 04/20/2026

NARRATIVE

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continued from LIC9099
In addition, observations of LPA revealed that the room in the photo shared by the complainant was not the same room that R1 lived in while at Vacaville Village Senior Living (photos on file)

An interview with S1, did reveal that S1 was wearing their work badge from Vacaville Village Senior Living, but review and magnification of the provided complaint photo does not appear to reveal the details of the badge.

Because R1 was not a Resident at the time the potential privacy violation might have taken place and because analysis of the photo revealed the location to be outside the room R1 lived in at Vacaville Village Senior Living and because it is unclear if the details of S1’s work badge can be made out , the allegation the privacy of a resident at Vacaville Village Senior Living having been violated is UNSUBSTAINTIATED.

A finding of unsubstantiated means, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur

Report was reviewed with Administrator whose signature here denotes receipt.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026

LIC9099 (FAS) - (06/04)

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