486803645-3-30-2026-21-AS-VBEI-DTFUMH-20260424154221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 03/30/2026
Date Signed: 03/30/2026 01:04:18 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
02/03/2026 and conducted by Evaluator Ali Deniz

COMPLAINT CONTROL NUMBER: 21-AS-20260203110945

FACILITY NAME:	VACAVILLE MEMORY CARE		FACILITY NUMBER:	486803645
ADMINISTRATOR:	CAMILLE BROWN		FACILITY TYPE:	740
ADDRESS:	431 NUT TREE ROAD		TELEPHONE:	(707) 449-1350
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	75	CENSUS: 43	DATE:	03/30/2026
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Executive Director, Camille Brown		TIME COMPLETED:	01:39 PM

ALLEGATION(S):

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Staff did not provide adequate supervision of a resident

INVESTIGATION FINDINGS:

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At approximately 12:25 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 allegation was investigated: “Staff did not provide adequate supervision of a resident.”

The complaint alleged that staff failed to properly secure the facility’s exterior gate, which allowed a resident to elope from the premises unsupervised and remain missing for an extended period before being located.
Per interview conducted with the Executive Director, two (2) separate incidents involving the resident’s exit-seeking behavior were confirmed. The facility submitted the first incident report on 07/15/2025, indicating that despite staff intervention efforts, the resident was able to open the exit door and leave the building.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260203110945

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: 03/30/2026

NARRATIVE

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Continued from LIC9099 page...

During the incident, staff contacted 911 immediately, and three (3) caregivers followed the resident at a safe distance until emergency responders arrived.

The second incident occurred on 11/24/2025. Documentation indicates that staff were closely monitoring the resident due to known exit-seeking behavior. Staff were unable to redirect the resident at the main gate and contacted paramedics for assistance.

During both incidents, staff maintained visual contact with the resident and continued to follow at a safe distance. LPA conducted interviews with the Executive Director and the resident’s spouse; however, there was insufficient evidence to determine that the resident was left unsupervised for an extended period of time.
Based on interviews conducted and records reviewed, the facility followed its established protocols and remained in compliance with Title 22 regulations; therefore, the 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: 03/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026

LIC9099 (FAS) - (06/04)

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