216804010-8-24-2026-21-AS-VBEI-DXK3C7-20260902180724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 216804010
Report Date: 08/24/2026
Date Signed: 08/24/2026 04:51:21 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
04/27/2026 and conducted by Evaluator Caitlynn Felias

COMPLAINT CONTROL NUMBER: 21-AS-20260427082427

FACILITY NAME:	VINCENT, THE		FACILITY NUMBER:	216804010
ADMINISTRATOR:	PARI,MANOUCHEHRI		FACILITY TYPE:	740
ADDRESS:	1 LAS GALINAS AVE		TELEPHONE:	(628) 336-1400
CITY:	SAN RAFAEL	STATE: CA	ZIP CODE:	94903
CAPACITY:	126	CENSUS: 81	DATE:	08/24/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director, Maria Cortes		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is not meeting resident's care needs

INVESTIGATION FINDINGS:

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At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a complaint investigation regarding the above allegation and met with Administrator/Executive Director, Maria Cortes.

During the course of the investigation, the Department reviewed documents, conducted interviews, and made observations. The following allegation was investigated, "Facility is not meeting resident's care needs." Complaint alleged that Resident 1 (R1) was observed to have an area of bruising their on right heel several days ago and had increased in size. R1 was recently hospitalized and Complainant was also concerned about their recurrent urinary tract infections (UTIs). Report stated that R1 seemed more confused and R1's responsible party contacted 911. After being evaluated by EMS, R1 was found to be hypotensive. Report further stated that the Complainant spoke with a medication technician who stated that R1 was bedbound and wheelchair bound. Per report, this staff member also stated that they weren't aware that R1 had a pressure wound on their right heel and that staff check on R1 every 2-3 hours. Complainant provided the Department with the
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026

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 3

Control Number 21-AS-20260427082427

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: 08/24/2026

NARRATIVE

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Continued from LIC9099

medication technician's name. Complainant also stated that R1's heel wound was observed on a Monday by their responsible party. Per report, R1 was seen at the hospital on a Thursday and was discharged from the hospital on 04/23/2026. Multiple attempts to speak with R1's responsible parties to determine a timeline and when they observed R1's heel were unsuccessful. Review of the facility staff roster and staff schedule for March and April 2026 was conducted. It was observed that there was no medication technician employed by the facility with the name provided by the Complainant.

A review of R1's file was conducted. R1's preappraisal dated 10/28/2025 stated that they have a history of refusing care and has recurrent urinary tract infections. Incident report submitted to Community Care Licensing (CCL) on 04/24/2026 stated that on 04/23/2026, R1 was observed to be weak and lethargic. Per incident report, R1 was also observed to have a brown discoloration on their right heel, which was noted to have redness, swelling, and warmth radiating up their leg. Facility contacted 911 for further assessment and R1 was taken to the hospital for further evaluation. Review of R1's after visit summary dated 04/23/2026 stated that R1 had a pressure injury and pneumonia. R1's medical paperwork did not note the stage of R1's pressure injury.

Review of facility medication technician communication log for the month of March and April 2026 notated the following:

03/30/2026: facility was waiting to receive a physician order for a UTI test for R1, and to collect a urine sample
04/03/2026: R1 returned from the hospital with new medication orders
04/04/2026, 04/05/2026, 04/11/2026: R1 was observed to attend their meals
04/22/2026, R1 was observed to have a sore on their right heel, Memory Care Director and R1's physician notified.
04/23/2026: Morning shift staff noted to keep R1's ankles floated; Afternoon shift noted that R1 was sent to the hospital for swelling of R1's right ankle.
04/24/2026: R1 was observed to be okay, was prescribed antibiotics, and for staff to continue to float R1's heel
04/25/2026: R1's ankle was observed to still be swollen and feet were elevated.
04/26/2026 and 04/27/2026; R1 observed to be doing okay, feet elevated.

Review of facility caregiver end of shift logs for April 2026 did not note any changes in condition for R1 until 04/22/2026. Per caregiver note dated 04/22/2026, R1 received a shower and was observed to have a wound on their right foot. Facility staff reported the change to the medication technician on duty and R1's family was notified. Additional caregiver note dated 04/23/2026 stated that R1 was sent to the hospital.

Continued on LIC9099C

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260427082427

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: 08/24/2026

NARRATIVE

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Continued from LIC9099C

Interview conducted with Staff Member 1 (S1) revealed that they observed R1 to have a swollen ankle when they came into
work on the afternoon of 04/23/2026. Per S1, they were notified about R1's ankle that same day, as they had been off for the previous two days. S1 stated they did not recall receiving information regarding R1's ankle prior to their two days off. Per S1, after R1 returned to the facility, they observed facility caregivers elevating R1's ankles.

Review of facility correspondence showed that R1's ankle discoloration was observed by the Memory Care Director (MCD) on 04/22/2026. Per correspondence, the MCD notified R1's family and responsible party of the change. Review of R1's file showed that on 04/23/2026, facility sent a physician communication fax to notify them of the observed change. A follow up physician communication fax was sent on 04/27/2026.

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 discussed and provided to Administrator/ Executive Director. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Caitlynn Felias
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026

LIC9099 (FAS) - (06/04)

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