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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 04/23/2025
Date Signed: 04/23/2025 05:16:03 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
02/21/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20250221084248
FACILITY NAME:VACAVILLE MEMORY CAREFACILITY NUMBER:
486803645
ADMINISTRATOR:MCGRANAHAN, JULIETFACILITY TYPE:
740
ADDRESS:431 NUT TREE ROADTELEPHONE:
(707) 449-1350
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:75CENSUS: DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Executive Director, Camille Brown, and Director of Operations, Karen Enciso TIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Staff do not respect residents privacy by posting pictures online without consent
Facility has insufficient staffing to meet the needs of residents in care
Facility is obstructing facility exit
INVESTIGATION FINDINGS:
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During the Office Meeting, Regional Manager, Carla Nuti-Martinez, Licensing Program Manager, Victoria Bertozzi, Licensing Program Analysts (LPAs) Caitlynn Felias and Ali Deniz delivered findings for this Complaint Investigation regarding the above allegations and met with Executive Director, Camille Brown, and Regional Director of Operations, Karen Enciso.

During the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegations were investigated, “Staff do not respect residents privacy by posting pictures online without consent, Facility has insufficient staffing to meet the needs of residents in care, and Facility is obstructing facility exit.”

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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 6
Control Number 21-AS-20250221084248
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 MEMORY CARE
FACILITY NUMBER: 486803645
VISIT DATE: 04/23/2025
NARRATIVE
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Continued from LIC9099

“Staff do not respect residents privacy by posting pictures online without consent” – Complainant alleged that Staff Member 1 (S1) violated residents’ privacy by posting pictures of residents on their personal social media account. LPAs were provided with photos, a video, and resident names. Review of S1’s file showed that they received a write up for posting activity events with residents on their personal social media account. Interview with prior Executive Director stated that S1 was given verbal permission to post events by a different Director since they did not have access to the business account. LPAs reviewed a sample size of 6 resident agreements. 5 of 6 files did not have signed social media consent forms or “model release agreements.” Per interview with Community Relations Director, all agreements were signed electronically and the consent forms could have missed during signing. LPAs identified that the residents provided in the photos did not have signed social media consent forms. Based on interviews conducted, document review, and observations made, this allegation is Substantiated.

“Facility has insufficient staffing to meet the needs of residents in care” – Complainant alleged that facility management is allowing one care staff member in each house and refuses to help when they are short-staffed. LPAs conducted interviews. Per interview with prior Executive Director, facility has not had adequate staffing to meet resident care needs. Interview with current Executive Director stated that 4 of the 5 facility houses require at least 2 staff members based on resident care needs such as transferring or bathing. Review of facility documents indicated that at least 6 residents in the community require 2-person assistance with care. Based on interviews conducted and document review, this allegation is Substantiated.

“Facility is obstructing facility exit” – Complainant alleged that facility management is instructing staff members to block the exit door to prevent residents from escaping. LPAs were provided with a photo during the investigation. Photo provided showed that a facility exit door was obstructed by a gray couch. Based on observations made, this allegation 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.

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

Exit interview conducted. Copy of report, LIC9099D (Deficiency Page), 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: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 21-AS-20250221084248
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 MEMORY CARE
FACILITY NUMBER: 486803645
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements – General
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...This requirement was not met as evidenced by: based on interviews conducted and document review, Licensee
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Licensee to submit written plan to ensure staffing is sufficient to meet resident care needs by POC Due Date of 04/25/2025.
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did not comply with the section cited above and ensure that all 5 homes at facility had adequate staffing to meet resident care needs. Licensee has at least 6 residents that require two staff member assistance. This poses an immediate health and safety risk to residents in care.
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Type A
04/25/2025
Section Cited
CCR
87468.2(a)(1)
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87468.2Additional Personal Rights of Residents in Privately Operated Facilities
(a) In addition to the rights listed in Section 87468.1...(1)To have a reasonable level of personal privacy accommodations...personal care & assistance...use of the Internet...this requirement was not met as evidenced by:
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Licensee to conduct training on the facility's social media policy, cell phones, and personal rights of residents. Training to include the following: Date, Topic, Name/Job Role, and Staff Signatures. Training to be submitted by POC Due Date of 04/25/2025.
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based on interviews conducted & document review, Licensee did not comply with the section cited above & Residents did not have signed social media consent forms prior to being on social media. This poses an immediate health and safety risk to residents in care.
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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: 04/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 21-AS-20250221084248
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 MEMORY CARE
FACILITY NUMBER: 486803645
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/23/2025
Section Cited
CCR
87202(a)
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87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...this requirement was not met as evidenced by: based on observsations
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Licensee to conduct training on keeping all facility exits clear and unobstructed, such as a fire drill, for all shifts (AM, PM, NOC). Training to include the following: Date, Topic, Name/Job Role, and Staff Signatures. Training to be submitted by POC Due Date of 04/25/2025.
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made, Licensee did not comply with the section cited above and ensure that all facility exits were unobstructed in the event of emergency. This poses an immediate health and safety risk to residents in care.
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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: 04/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
02/21/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20250221084248

FACILITY NAME:VACAVILLE MEMORY CAREFACILITY NUMBER:
486803645
ADMINISTRATOR:MCGRANAHAN, JULIETFACILITY TYPE:
740
ADDRESS:431 NUT TREE ROADTELEPHONE:
(707) 449-1350
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:75CENSUS: DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Executive Director, Camille Brown, and Director of Operations, Karen Enciso TIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Staff are not adequately trained to meet the needs of residents in care
INVESTIGATION FINDINGS:
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During the Office Meeting, Regional Manager, Carla Nuti-Martinez, Licensing Program Manager, Victoria Bertozzi, and Licensing Program Analysts (LPAs) Caitlynn Felias and Ali Deniz delivered findings for this Complaint Investigation regarding the above allegations and met with Executive Director, Camille Brown, Regional Director of Operations, Karen Enciso.

During the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegation was investigated, “Staff are not adequately trained to meet the needs of residents in care.” Complainant alleged the following: S1 was not adequately trained to meet the needs of residents in care, stating that S1 was observed to be performing nail care on hospice and diabetic residents.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 21-AS-20250221084248
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 MEMORY CARE
FACILITY NUMBER: 486803645
VISIT DATE: 04/23/2025
NARRATIVE
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Continued from LIC9099

LPAs were provided with a photo which showed S1 standing next to a male resident wearing gloves. The male resident is sitting down at a table. From the photo provided, it is unclear what S1 is doing in the photo as their hands are obstructed by items on the table. Review of facility’s Clinical Policy and Procedure Manual for Podiatry and Nail Care states the following: “Policy: The Community will arrange or make available to residents foot and nail care. Procedure: Personal Care Assistants will not trim toenails, smooth corns, calluses, etc. The Resident Care Director will schedule podiatry appointments for all foot and/or nail care other than cleaning and moisturizing…” Review of S1’s file showed that they did not have training to provide nail care. Interview conducted with S1 stated that they provided an activity called “Nail Spa” which included placing warm towels over resident nails, filing and painting them. S1 denied cutting or trimming resident nails. Interviews conducted with other facility staff provided conflicting information. 4 of 8 interviews stated that S1 has not been seen cutting or trimming resident nails, while 4 of 8 interviews stated that S1 has been seen cutting or trimming nails. Based on interviews conducted, document review, and observations made, this 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 violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report 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: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6