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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 12/11/2025
Date Signed: 12/11/2025 03:18:11 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
09/09/2025 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20250909141835
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: 43DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:TIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Facility did not follow infection control plan
INVESTIGATION FINDINGS:
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At approximately 01:15PM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to continue a complaint Investigation and delivered the findings regarding the above allegation and met with Administrator, Camille Brown.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegation was investigated, “Facility did not follow infection control plan”.

The complaint alleged that the facility failed to follow its infection control plan by allowing residents with suspected scabies, COVID-19 exposure, or other contagious conditions to move freely throughout the facility without appropriate isolation or precautions. LPA conducted an unannounced visit, interviewed staff, reviewed resident records, and assessed the facility’s infection control practices. The Administrator reported that the facility had no confirmed scabies cases.
Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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-20250909141835
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: 12/11/2025
NARRATIVE
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Continued from LIC9099...

One resident (R1) was discharged from the hospital on 09/03/2025 with documentation indicating only a possible exposure to scabies. No diagnosis was confirmed. The facility reported that upon the resident’s return from the emergency department, isolation precautions were initiated immediately, Personal Protective Equipment (PPE) was made available, and staff were notified of the precautionary measures. LPA observed that the facility maintained sufficient PPE supplies and that staff were aware of proper usage.

During the facility tour, LPA did not observe any residents with visible rashes or symptoms consistent with scabies, nor did LPA observe lapses in infection control practices. No evidence was provided to indicate that symptomatic residents were permitted to wander throughout the facility without precautions. Staff interviews were consistent in reporting that no residents were diagnosed with or treated for scabies, and no active outbreak was present.

Based on the interviews, observations, and documentation reviewed, there is insufficient evidence to support the allegation that the facility failed to follow its infection control plan.

Therefore, 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.

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: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
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