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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 03/04/2025
Date Signed: 03/04/2025 11:17:33 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
12/04/2024 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20241204123831
FACILITY NAME:VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THEFACILITY NUMBER:
486803806
ADMINISTRATOR:WHINERY,MORGANFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:250CENSUS: 162DATE:
03/04/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tony IbarraTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff is not providing assistance in attending resident council meetings for those residents who request it
Staff are not serving meals timely
Staff are not following special diet orders
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced and met with Tony Ibarra for the purpose of delivering findings on this complaint. This investigation consisted of interviews, document reviews, and six unannounced site visits on 12/10, 12/17, 12/26/24, 01/13, 2/11, 2/21/25 . The Complainant was asked if Complainant knew of any residents denied assistance in attending resident council meetings; Complainant stated, "Not that I know of;" Notices for Council Meetings are posted in lobby; Six of six unannounced site visits at lunchtime found that meals were served timely with adequate staff and that residents were served promptly; It's been reported that the 2024 Christmas meal may have resulted in some residents waiting approximately an hour to be served based upon Complainant statement and statement of Witness # 2; Six of Six unannounced inspections of the kitchen, dining room and dining service found no violations of Title Twenty-Two Regulations; Complainant states that Resident (R1) has not been provided the special diet prescribed by R1's physician; When interviewed, family member of R1 complained of a lack of variety in the food served but did not indicate the food was not compliant with the prescribed diet; A review of the facility's protocol for special diets complies with regulations. Based upon interviews with staff and a review of the
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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 4
Control Number 21-AS-20241204123831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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, THE
FACILITY NUMBER: 486803806
VISIT DATE: 03/04/2025
NARRATIVE
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Resident's facility's file , LPA confirmed that R1 is on a restricted diet and that kitchen staff are aware of the restricted diet; The Facility's Assistant Chef was interviewed and expressed knowledge of the restricted diet and provided a list of the foods prepared for R1 which comply with the restrictions. Although the allegations may be true, based upon the documents reviewed, statements taken and observations at unannounced site visits, there is not a preponderance of evidence to prove, or disprove, the allegations. Therefore, the allegations are UNSUBSTANTIATED.

Report left.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
12/04/2024 and conducted by Evaluator David Leibert
COMPLAINT CONTROL NUMBER: 21-AS-20241204123831

FACILITY NAME:VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THEFACILITY NUMBER:
486803806
ADMINISTRATOR:WHINERY,MORGANFACILITY TYPE:
740
ADDRESS:3350 CHERRY HILLS COURTTELEPHONE:
(707) 425-3588
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:250CENSUS: 162DATE:
03/04/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Tony IbarraTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility does not have the required postings
INVESTIGATION FINDINGS:
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Licensing Program Analyst Leibert arrived unannounced and met with Tony Ibarra for the purpose of delivering findings on this complaint. This investigation consisted of interviews, document reviews, and seven unannounced site visits. Complainant has alleged that the facility has not posted the notices for residents and others that are required by Title Twenty-Two Regulations. At an unannounced site visit to the facility conducted on December 10, 2024, it was noted that the sign regarding complaint protocols which was posted did not comply with regulation as it was too small, measuring 10 x 12 inches. No sign addressing residents rights was noted. Based upon the statements and observations, the preponderance of evidence standard has been met. Therefore, the allegation is 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:
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20241204123831
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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, THE
FACILITY NUMBER: 486803806
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/04/2025
Section Cited
CCR
87468(c)
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87468© Personal Rights. Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. ***Based on statements and observation, this requirement not met as evidenced by:
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POC: Cleared at time of visit. Required postings are currently in place.
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Inspection on 12/10/24 found complaint sign posting was not required size and no residents’ rights posted. This posed a potential denial of residents’ personal rights.
POC: Cleared at time of visit. Required postings are currently in place.
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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.
SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4