216804010-1-15-2026-21-AS-VBEI-DQPPSY-20260126103503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804010
Report Date: 01/15/2026
Date Signed: 01/15/2026 04:57:12 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
12/08/2025 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20251208131803

FACILITY NAME:	VINCENT, THE		FACILITY NUMBER:	216804010
ADMINISTRATOR:	PARI,MANOUCHEHRI		FACILITY TYPE:	740
ADDRESS:	1 LAS GALINAS AVE		TELEPHONE:	(628) 336-1400
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	126	CENSUS: 89	DATE:	01/15/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Executive Director/Administrator, Pari Manouchehri		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is not clean, safe, sanitary or in good repair at all times

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 and made observations. The following allegation was investigated, “Facility is not clean, safe, sanitary or in good repair at all times” Complaint alleged that there is no laundry or hand soap supply in the community. Complaint also stated that the facility walkie talkies don’t work and that resident pendant calls don’t go through or can’t be acknowledged by facility staff.

Review of facility’s pendant call logs for November and December 2025 indicated that resident pendant calls were pressed and responded to by facility staff. During visit conducted on 01/15/2026, LPA observed that the
Continued on LIC9099C

Unsubstantiated

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)

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Control Number 21-AS-20251208131803

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

facility pendant call system was operable and that facility staff had functioning walkie talkies. LPA also observed that all public restrooms had hand soap available, and facility laundry rooms had a supply of laundry detergent available for use.

Interview conducted with Executive Director stated that soap is ordered through HD Supply and is automatically ordered on a monthly cycle. Facility provided invoices for October, November, and December 2025 showing proof of ordered soap.

Based on record review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that a 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 violations did or did not occur.

Exit interview conducted. Copy of report discussed and provided to Executive Director/Administrator. 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)

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