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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804297
Report Date: 06/16/2026
Date Signed: 06/16/2026 10:06:29 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
05/04/2026 and conducted by Evaluator Star Stevenson
COMPLAINT CONTROL NUMBER: 21-AS-20260504121008
FACILITY NAME:VACAVILLE VILLAGE SENIOR LIVINGFACILITY NUMBER:
486804297
ADMINISTRATOR:SAMANIEGO, AGUSTINFACILITY TYPE:
740
ADDRESS:2061 PEABODY RDTELEPHONE:
(323) 902-6000
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:160CENSUS: 76DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Agustin Samaniego-AdministratorTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Personal Rights
INVESTIGATION FINDINGS:
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On 06/16/2026 Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to deliver complaint findings of a complaint received by Community Care Licensing (CCL) on 05/04/2026 in which complainant alleged that, “staff have attitudes and act like they don’t care about the residents” with complainant further indicating that, “staff don’t speak to complainant and are always on their phones”

Upon interviewing complainant, LPA learned that their concern for “attitude” and lack of concern for residents is mostly isolated to one staff member, S4, rather than a systemic issue with all staff at Vacaville Village Senior Living. During a visit to Vacaville Village Senior Living, LPA learned that upon arrival to the facility, all care staff are required to pick up a company iphone that has the facility-wide call light alert system loaded on mobile phones. It is from these iphones that staff get alerts about who needs help in other rooms and that residents will often see caregivers looking at the company iphone when alerts for help pop up.

On 06/04/2026 LPA received a copy of a “Cell Phones/Cameras/Communication Devices and Breaks at Work” document signed by S4 on 04/15/2026 that advises, employees should not be using their personal phones or devices at work.

Continued LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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-20260504121008
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: 06/16/2026
NARRATIVE
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Continued from LIC9099
In addition LPA obtained copies of the Employee handbook where on page 51 of 64 it indicates that making or taking personal calls of more than three (3) minutes is not allowed, page 48 of 64 of the same handbook indicates employees are to be polite, courteous…attentive to every customer…that Residents come first and that Residents are to be treated courteously and always given proper attention.

Additional interviews with three random residents had residents R1, R2, R3 raising no concern for staff “attitudes” or staff lacking concern for residents or of staff were constantly on the phones while working.

Finally LPA obtain a signed copy of “Conduct Expectations” signed by S4 acknowledging that professional, courteous and polite conduct is required at all times and acknowledging that disciplinary or corrective actions could be taken against employees who fail to maintain a positive, kind, welcoming attitude toward others or those that use personal phone, or other entertainment devices during work time. In addition, the Conduct Expectation document forbids employees to use personal devices (phones or cameras) for making or receiving personal calls or texts that are not work-related during work time, and well as, violating Residents Rights like neglect or failing to answer call lights.

Because of conflicting information about the concern that staff show for residents and because staff use a company owned iphone call light alert system, the above allegation is unsubstantiated.

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

Exit interview conducted. Copy of report discussed and provided to Administrator Agustin Samaniego whose signature here denotes receipt.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
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