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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 03/11/2026
Date Signed: 03/11/2026 02:48:21 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
11/06/2025 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20251106091142
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: 41DATE:
03/11/2026
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:TIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff do not ensure faucets used by residents for personal care deliver hot water
Staff do not ensure resident’s care needs are met
Staff do not dispense medications as prescribed
Staff do not keep accurate resident records
Staff do not safeguard resident's belongings
Staff do not ensure facility is maintained clean
Staff do not maintain facility free of odors
Staff do not provide planned activities
INVESTIGATION FINDINGS:
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At approximately 02:15 PM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to deliver findings for a complaint investigation regarding the above allegation and met with Executive Director, Camille Brown.
During the course of the investigation, the Department conducted interviews, reviewed documents, and made observations. The following allegations were investigated: “Staff do not ensure faucets used by residents for personal care deliver hot water, Staff do not ensure resident’s care needs are met, Staff do not dispense medications as prescribed, Staff do not keep accurate resident records, Staff do not safeguard resident's belongings, Staff do not ensure facility is maintained clean, Staff do not maintain facility free of odors, and Staff do not provide planned activities.”

“Staff do not ensure faucets used by residents for personal care deliver hot water” – The complaint alleged that faucets in the resident’s room did not provide hot water for personal care, preventing the resident from bathing properly.
Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
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 4
Control Number 21-AS-20251106091142
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: 03/11/2026
NARRATIVE
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Continued from LIC9099 page...
During the investigation, LPA reviewed facility records and documentation. On 11/06/2025, the facility notified Community Care Licensing that one of the five houses experienced a hot water system failure. The facility reported that residents’ hot water needs, including those in the kitchen, would be mitigated by implementing safety measures. An outside maintenance vendor was contacted immediately, and repairs were scheduled.
LPA attempted to obtain additional information from the complainant but did not receive a response. No additional evidence or documentation was provided to support the allegation.
Based on interviews conducted and documents reviewed, this allegation is Unsubstantiated.
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“Staff do not ensure resident’s care needs are met” - The complaint alleged that staff do not assist the resident with showering, mobility using a walker, or other personal care needs.
During the investigation, LPA conducted interviews with facility staff and reviewed resident records, including the resident’s care plan and service records. Staff reported that residents receive assistance with activities of daily living in accordance with their assessed needs and care plans. Documentation reviewed by LPA indicated that the resident receives assistance with personal care and mobility support as needed.
LPA conducted observations of the facility during the visit. No concerns were observed regarding staff providing assistance to residents with mobility or personal care needs at the time of the visit.
LPA attempted to obtain additional information from the complainant but did not receive a response. No additional documentation or evidence was provided to support the allegation.
Based on interviews conducted, records reviewed, and observations made, this allegation is Unsubstantiated.
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“Staff do not dispense medications as prescribed” - The complaint alleged that staff hand medications to the resident and leave without confirming ingestion; pills are sometimes found on the floor or in drawers.
During the investigation, LPA interviewed facility staff responsible for medication administration and reviewed medication administration records (MARs). Staff reported that the resident sometimes refuses taking medications. Record reviews did not indicate irregularities related to medication administration for the resident.
LPA attempted to obtain additional information from the complainant but did not receive a response. No additional information or evidence was obtained to corroborate the allegation.
Based on interviews conducted and records reviewed, the allegation is Unsubstantiated.
Continued on LIC9099-C page...
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20251106091142
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: 03/11/2026
NARRATIVE
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Continued from LIC9099-C page...
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“Staff do not keep accurate resident records” - The complaint alleged that medication refusals and administration were not properly recorded in facility logs.
During the investigation, LPA reviewed facility records including medication administration records and resident documentation. Records reviewed by LPA appeared to be maintained and included documentation of medication administration.
LPA attempted to obtain additional information from the complainant but did not receive a response. No additional evidence was provided to support the allegation.
Based on records reviewed and information obtained during the investigation, this allegation is Unsubstantiated.
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“Staff do not safeguard resident's belongings” - The complaint alleged that resident’s food and personal items have gone missing, including repeated loss of food provided by the reporting party.
During the investigation, LPA interviewed staff regarding procedures for safeguarding resident belongings. Staff reported that residents maintain personal belongings in their rooms and that staff do not have information regarding missing items belonging to the resident. LPA attempted to obtain additional information from the complainant but did not receive a response. No supporting documentation or evidence was obtained.
Based on interviews conducted and documentation reviewed, this allegation is Unsubstantiated.
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“Staff do not ensure facility is maintained clean” - The complaint alleged that resident’s room and Memory Care unit are cleaned only once weekly, resulting in unsanitary conditions by the end of the week.
During the investigation, LPA conducted observations of the facility, including common areas. At the time of the visit, the areas observed appeared to be maintained in a clean and sanitary condition. LPA interviewed staff regarding housekeeping schedules. Staff reported that housekeeping services are conducted once a week, with additional cleaning performed as needed.
LPA attempted to obtain additional information from the complainant but did not receive a response. No additional evidence was obtained to support the allegation.
Based on observations made and interviews conducted, this allegation is Unsubstantiated.
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“Staff do not maintain facility free of odors” - The complaint alleged that unit smells of urine and feces, indicating poor odor control.
Continued on LIC9099-C page
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20251106091142
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: 03/11/2026
NARRATIVE
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Continued from LIC9099-C page...

During the investigation, LPA conducted observations of the facility including the Memory Care unit and common areas. At the time of the visit, LPA did not observe strong or persistent odors indicating unsanitary conditions. Staff reported that routine housekeeping and resident care practices are conducted to maintain the facility in a sanitary condition.
LPA attempted to obtain additional information from the complainant but did not receive a response. No additional evidence was obtained to corroborate the allegation.
Based on observations made during the visit and information obtained, this allegation is Unsubstantiated.

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“Staff do not provide planned activities” - The complaint alleged that Residents do not participate in structured activities; only watch TV.
During the facility visit on 12/12/2025, LPA observed residents participating in a Christmas decoration activity alongside care staff members. Staff were observed engaging with residents and providing support during the activity. Residents appeared involved and actively participating.
LPA attempted to obtain additional information from the complainant but did not receive a response. No additional information or documentation was provided to support the allegation.
Based on interviews conducted and observations made during the investigation, this allegation is Unsubstantiated.

Based on interviews conducted, documents gathered 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: 03/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4