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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216804010
Report Date: 01/15/2026
Date Signed: 01/15/2026 04:55:22 PM

Substantiated


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
12/10/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20251210165426
FACILITY NAME:VINCENT, THEFACILITY NUMBER:
216804010
ADMINISTRATOR:PARI,MANOUCHEHRIFACILITY TYPE:
740
ADDRESS:1 LAS GALINAS AVETELEPHONE:
(628) 336-1400
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:126CENSUS: 89DATE:
01/15/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Executive Director/Administrator, Pari ManouchehriTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not properly transfer a resident in care resulting in resident sustaining fractures
INVESTIGATION FINDINGS:
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At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a Complaint Investigation regarding the above allegation and met with Executive Director, Pari Manouchehri.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegation was investigated, “Staff did not properly transfer a resident in care resulting in resident sustaining fractures.” Complaint alleged that Resident 1 (R1) sustained fractures to their right ankle and toe due to facility staff not placing R1 properly in their hoyer lift during a transfer. Complaint also stated concerns that R1 sustained a knee fracture due to a fall from their bed.
Interview conducted with Memory Care Director revealed that on 08/17/2025, two staff members were assisting R1 while using the hoyer lift. Per interview, R1’s hoyer lift may have been set up wrong because
Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
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-20251210165426
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: VINCENT, THE
FACILITY NUMBER: 216804010
VISIT DATE: 01/15/2026
NARRATIVE
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Continued from LIC9099

one of the leg slings came off causing R1’s body weight to shift and fall. The two staff members assisting R1 focused on helping their upper body because they didn’t want R1 to hit their head. R1’s toe and ankle hit the metal of the hoyer lift because R1’s legs are not functional and R1 cannot move them. Per interview, on 08/17/2025, R1 was observed to have no apparent injuries and an internal incident report was made. On 08/18/2025, R1 was observed to have redness so R1’s Responsible Party and Primary Care Physician were notified. Facility requested a home health nurse to come to the facility for further assessment.

Review of R1’s incident reports showed that on 08/22/2025, they were sent to the ER where it was found that they had a fractured big toe and ankle. Report also stated that the injury was from a hoyer lift incident that occurred on 08/17/2025 and that facility staff received additional hoyer lift training on 08/19/2025.

Review of R1’s progress notes showed the following:

· On 08/18/2025, facility staff observed that resident’s left leg was swollen and complained of pain when touched.

· On 08/19/2025, R1 was observed laying on top of their hoyer lift sling on the floor. Per progress note, one of the loops of the sling was not on it causing R1 to wing to the side. R1 sustained a bruise on their left arm and a swollen big toe that had redness.

· On 08/20/2025, R1 was observed to still have swelling and redness to the area.

· On 08/22/2025, R1’s home health agency conducted a visit and requested for an x-ray for R1

· On 08/23/2025, R1 returned to the facility with a fractured ankle and broken big toe.

Review of R1’s incident reports and progress notes indicated that a separate incident occurred on 11/18/2025. Per report, R1 was found on the floor by facility staff and was sent to the hospital for further evaluation. Per incident report, preliminary tests indicated that R1 did not sustain any fractures or major injuries. Review of R1's medical records stated that x-rays revealed R1 sustained leg fractures and was admitted to a skilled nursing facility. Facility addressed the knee incident appropriately.



Based on record review, interviews conducted, and observations made, the allegation of "Staff did not properly transfer a resident in care resulting in resident sustaining fractures" is Substantiated. A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Continued on LIC9099C

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20251210165426
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: VINCENT, THE
FACILITY NUMBER: 216804010
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/16/2026
Section Cited
CCR
87466
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87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes...and that appropriate assistance is provided...This requirement was not met as evidenced by: based on record review and interviews conducted, Licensee did not ensure that
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Licensee to submit self-certification that in-service training will be conducted for all care staff on these topics: when to call 911 and observing changes in condition for residents. Self-Certification to be submitted by POC due date of 01/16/2026. Training to include the following: Date, Topic, Job Role, Staff
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Resident 1 (R1) received timely medical care. R1 had an incident with their hoyer lift on 8/17/25. They were observed to have swelling and redness on 8/18/25 but did not get assessed until 8/22/25. This poses an immediate health, safety, or personal rights risk to residents in care.
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Names, and Signatures. Training to be submitted to CCL for review and approval by POC due date of 01/26/2026.
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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: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20251210165426
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: VINCENT, THE
FACILITY NUMBER: 216804010
VISIT DATE: 01/15/2026
NARRATIVE
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Continued from LIC9099C

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

**An immediate Civil Penalty in the total amount of $500 has been issued for not seeking timely medical care (See LIC-421IM). An additional civil penalty may be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).**

Exit interview conducted. Copy of report, Plan of Corrections, and Appeal Rights, discussed and provided to Executive Director. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4