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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 05:19:48 PM

Unfounded


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
03/21/2025 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20250321091423
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 Regional Director of Operations, Karen Enciso.TIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Licensee using an Admission Agreement that is not lawful
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, and 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, “Licensee using an Admission Agreement that is not lawful.” Complainant alleged that the facility residency application for Pacifica Senior Living in Vacaville requires family to accept financial liability which is a violation of 42 CFR 483.15(a)(3).

Continued on LIC9099C
Unfounded
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 2
Control Number 21-AS-20250321091423
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 LIC9099C

LPAs Felias and Deniz conducted an investigation into the allegation of “Licensee using an Admission Agreement that is not lawful” specifically related to Title 42 regulation section 486.15(a)(3) which states “42 CFR 483.15(a)(3), the facility must not request or require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may request and require a resident representative who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.” Vacaville Senior Living is a Community Care Licensed facility, and the oversight is under Title 22 Regulations not Title 42. In reviewing Title 22 regulations there is not language that coincides with the section cited above. This allegation is Unfounded.

A finding that the complaint is Unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

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: 2 of 2