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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803806
Report Date: 12/04/2025
Date Signed: 12/04/2025 02:49:19 PM

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
10/10/2025 and conducted by Evaluator Elias Magdaleno
COMPLAINT CONTROL NUMBER: 21-AS-20251010104902
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: 164DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Jesse Sias, Regional Director of OperationsTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility did not meet resident's care needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magdaleno arrived unnanounced to continue a complaint investigation and deliver findings regarding the above allegation(s) and met with Regional Director of Operations, Jesse Sias.

Facility did not meet resident's care needs - Reporting Party (RP) alleges that resident (R1) was observed laying on an air mattress without any sheets during two (2) separate visits and the room was unkept and had a musty smell. Further, RP alleges that R1 developed two (2) sores due to lack of repositioning. During the course of this investigation LPA conducted interviews, made observations, and reviewed records. Interview with Home Health Nurse (HR) indicated that R1 had blisters in the past but currently did not present with any, HR declined any further comments. Interview with staff (S1) indicated that R1 had blisters in their back in the past that did not open and were now healed, but S1 stated R1 may have a new blister on their toe.

Continued LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 21-AS-20251010104902
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: VILLAGE AT RANCHO SOLANO ASSISTED LIVING, THE
FACILITY NUMBER: 486803806
VISIT DATE: 12/04/2025
NARRATIVE
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Continued from LIC9099...

S1 also stated that R1 can become combative and often refuses any assistance from staff. Interview with Health and Wellness Director (HWD) indicated that R1 had blisters that healed before becoming open sores and therefore were not staged. Interview with R1 indicated that they are checked on, provided assistance when required, have all their meals delivered to them, and have their room cleaned at least once a week. Further interview with R1 indicated that they have had issues at the facility with call alarm waiting times, assistance with shifting in bed, and developed four (4) sores on their back. LPA observed that R1’s room was fully furnished and clean, and LPA did not observe a musty odor present. R1 was observed to be lying in bed with sheets covering them and a caregiver was observed to check on them regularly. Review of third-party Resident Service Note Charting Forms from 06/2025-11/2025 indicated Stage 1 pressure wound that healed within two (2) weeks. Review of Resident notes dated 06/2025-10/2025 show an average of three (3) checks a day for R1 with daily notes documenting R1 refusal of care. Although the allegation may have happened or is valid, the Department has found there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies cited. Exit interview conducted with Regional Director of Operations, whose signature on form confirms receipt.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2