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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 09/12/2025
Date Signed: 09/12/2025 01:28:48 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
05/16/2025 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20250516100242
FACILITY NAME:VACAVILLE MEMORY CAREFACILITY NUMBER:
486803645
ADMINISTRATOR:CAMILLE BROWNFACILITY TYPE:
740
ADDRESS:431 NUT TREE ROADTELEPHONE:
(707) 449-1350
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:75CENSUS: 50DATE:
09/12/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator, Camille BrownTIME COMPLETED:
01:54 PM
ALLEGATION(S):
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Staff neglect resulted in residents being hospitalized
Staff inappropriately touches the residents while in care
Staff leaves the residents unattended
INVESTIGATION FINDINGS:
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At approximately 09:40AM, Licensing Program Analyst (LPA) Deniz arrived unannounced to continue a Complaint Investigation regarding the above allegations and met with Administrator, Camille Brown.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The Department investigated the following allegations “Staff neglect resulted in residents being hospitalized, Staff inappropriately touches the residents while in care, and Staff leaves the residents unattended.” Complaint alleged that Staff Member 1 (S1) leaves the residents unattended to hang out with other staff members, that residents have fallen and have gone to the ER due to S1 leaving them unattended, and that S1 grooms male residents’ private areas. Additional report received stated that Staff Member 2 (S2) also grooms male residents’ private areas. Multiple attempts to contact Complainant for more information were unsuccessful. The Department was unable to obtain additional information such as which residents were left unattended, which residents fell, when these residents were sent to the ER and which residents were having their private areas groomed.
Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
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-20250516100242
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: 09/12/2025
NARRATIVE
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Continued from LIC9099...

Due to lack of information provided by the Complainant, the Department was unable to determine if staff neglect due to being left unattended resulted in residents being hospitalized. Interview with S1 denied the allegation that they leave residents unattended. 9 of 13 staff interviews stated that they haven’t observed or seen S1 or other facility staff leaving the residents unattended. 4 of 13 interviews stated that they have seen or heard of facility staff leaving residents unattended but only 1 of 13 interviews identified S1. Interviews conducted revealed that there are usually two staff members in each house as well as two medication technicians available each shift. During staff breaks, facility staff members will stagger their time to ensure that there is always 1 staff member in the house to supervise the residents. Interviews conducted with S1 and S2 denied the allegations that they groom or shave the private areas of male residents. 10 staff interviews stated that they haven’t observed or heard of facility staff grooming or shaving the private areas of male residents.

Based on interviews conducted these allegations are 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.

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: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2