216804010-6-15-2026-21-AS-VBEI-DVRSF9-20260707134958

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804010
Report Date: 06/15/2026
Date Signed: 06/15/2026 02:54:49 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
05/11/2026 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20260511105146

FACILITY NAME:	VINCENT, THE		FACILITY NUMBER:	216804010
ADMINISTRATOR:	CORTES, MARIA		FACILITY TYPE:	740
ADDRESS:	1 LAS GALINAS AVE		TELEPHONE:	(628) 336-1400
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	126	CENSUS: 85	DATE:	06/15/2026
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Executive Director, Maria Cortes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility not assisting resident with medications as prescribed.

INVESTIGATION FINDINGS:

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At approximately 8:25AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for a complaint investigation regarding the above allegations. Executive Director, Maria Cortes, arrived during visit at approximately 9:00AM.

There is an allegation of “Facility not assisting resident with medications as prescribed.” Complaint alleged that facility did not properly administer Resident 1’s (R1’s) Quetiapine medication as ordered. Per report, on 03/20/2026, R1’s Quetiapine was prescribed as a PRN medication, or “as needed medication." On 03/24/2026, R1's medication was changed to a scheduled medication to be given every night at bedtime. During a visit on 04/09/2026, it was observed that R1’s Quetiapine was listed as a PRN on their medication list. During another visit on 05/07/2026, it was observed that R1’s Quetiapine was still listed as a PRN and was last given on 04/15/2026.

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

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-20260511105146

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: VINCENT, THE	FACILITY NUMBER: 216804010
	VISIT DATE: 06/15/2026

NARRATIVE

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Continued from LIC9099

A review of R1's documents was conducted. On 03/18/2026, the facility received a physician order for R1's Quetiapine. This order stated "25MG, take 1/2 tablet (12.5MG) by mouth daily at bedtime as needed for agitation." Review of R1's medication authorization record (MAR) showed that facility staff entered this order manually on paper and administered the Quetiapine from 03/18/2026 to 03/22/2026.

On 03/23/2026, the facility received a new order for R1 which stated, "Quetiapine, 25MG, take 1/2 tablet (12.5MG) daily at bedtime." Review of R1's MAR showed that facility staff entered the new order manually on paper and administered Quetiapine from 03/23/2026 to 03/31/2026.

Review of R1's medication list for 04/09/2026 stated R1's Quetiapine order as, "25MG take one-half tablet (12.5MG) by mouth at bedtime for insomnia, dementia related agitation." Review of R1's MAR for April 2026 showed that R1's Quetiapine order was manually entered on paper as "Quetiapine, 25MG take half tablet by mouth at bedtime." It was observed that facility administered Quetiapine for April 2026 appropriately per the paper MAR.

Facility received an updated medication list for R1 on 05/07/2026. This list also stated that "25MG take one-half tablet (12.5MG) by mouth at bedtime for insomnia, dementia related agitation." Review of R1's MAR for May 2026 showed that R1's Quetiapine order was manually entered on paper as "Quetiapine, 25MG take half tablet by mouth." It was observed that R1 was administered Quetiapine for May 2026 appropriately per the paper MAR.

Interview conducted with Health Services Director stated that after sending the new orders to the pharmacy, the pharmacy didn't input or profile R1's Quetiapine orders correctly into the electronic MAR. As a result, facility staff started a paper MAR to document when the Quetiapine was being given to R1.

Based on record review, interviews conducted, and observations made, this allegation is Unsubstantiated. A finding that a 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 and LIC811 (Confidential Names) discussed and provided to Executive Director/Administrator. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

LIC9099 (FAS) - (06/04)

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