480111090-3-18-2026-21-AS-VBEI-DSCV3H-20260320160447

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 480111090
Report Date: 03/18/2026
Date Signed: 03/18/2026 06:20:38 PM

Substantiated

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
03/13/2026 and conducted by Evaluator Christi Coppo

COMPLAINT CONTROL NUMBER: 21-AS-20260313093610

FACILITY NAME:	GILCREST GROUP HOME, THE		FACILITY NUMBER:	480111090
ADMINISTRATOR:	CHERYL DAVIDSON		FACILITY TYPE:	735
ADDRESS:	447 GILCREST		TELEPHONE:	(707) 563-5543
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	9	CENSUS: 7	DATE:	03/18/2026
		UNANNOUNCED	TIME BEGAN:	03:12 PM
MET WITH:	Cheryl Davidson, Administrator		TIME COMPLETED:	06:35 PM

ALLEGATION(S):

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Physical Plant concerns: inoperable restrooms, mold, holes in the walls, broken furniture and overall lack of upkeep.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to open an investigation into the above allegation. LPA was greeted by Jackie Morris house manager. LPA spoke with Administrator via phone.

Complaint alleges that facility has inoperable restrooms, mold, holes in the walls, broken furniture and overall lack of upkeep.

During investigation LPA observed parts of the flooring in the staff office to be a light brown color. LPA noticed area by food storage to bow under pressure of walking on it, it was covered by a rug. LPA lifted up rug to find that the flooring was black in portions. Chair cushions soiled with yellow, red, and purple substances. LPA observed damage to wall by laundry dryer including open areas where sheet rock is no longer there and inner walls exposed. Exposed areas are colored black with gray and blue fuzzy substance. Some areas

Continued on 9099C...

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

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-20260313093610

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: GILCREST GROUP HOME, THE	FACILITY NUMBER: 480111090
	VISIT DATE: 03/18/2026

NARRATIVE

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Continued from 9099...

also have a brown and rust color to them. Wall in living area has an indentation and crack surrounding the indentation. A hole in the ceiling of approximately 4 inches in height and 3 inches wide. Opposite wall in living area has a vertical crack in the wall approximately 2.5 feet in length, starting from about 6 inches from the ceiling down to about the middle of the wall. Walls have both vertical and horizontal cracking in all common areas as well as in back bedroom #4. Living area off kitchen and kitchen had many flies present, approximately 20-30 flies. Additionally, facility has strong malodor of smoke and something rotting.

LPA toured bedrooms of facility and found them to have very minor damage such as chips and scrapes in the paint and on the baseboards. Floor vent in one room is warped, or floor is warped, such that the vent screen cannot sit flush with the floor.

LPA observed cabinet under kitchen sink. Floor of cabinet warped such that it slopes down from the left to the right, the middle is bow down and such that it exposes an unidentifiable part of the wall. Also present was a bucket half filled with water, bucket placed directly under 'U" portion of sink drain. Additionally, the back and side portion of the cabinet has large areas of black substance. Each area approximately 4 or 5 inches high and 2 to 3 inches wide.

Facility has 5 bathrooms. one of which LPA was not granted access. LPA observed Out of Order sign but could not open the door, despite there being a hole where otherwise a door handle would be present. Caregiver explained that bathroom is out of order and to the best of their recollection has been out of order since before November of 2025. LPA asked when repairs would be completed. Caregiver said repairs were originally planned but that the repairs were found too costly so facility will not be repairing them. LPA observed all other bathrooms used by residents to be operational. However, LPA did observe holes behind toilet in bathroom used by all residents to be deep enough such that there was no sheet rock remaining, ceiling light fixture was still attached but hole present in ceiling and ceiling exposed. Bathroom in room #1 has horizontal rectangular hole approximately 2 feet long behind left side of toilet extending to right side.

Continued 9099C(2)...

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260313093610

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: GILCREST GROUP HOME, THE	FACILITY NUMBER: 480111090
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/18/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/01/2026 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Based on LPA observation the licensee did not comply with the section cited above in that LPA holes in ceiling and walls, rodent	1 2 3 4 5 6 7	Facility to submit video of repairs of all holes in walls and ceilings, cleaned facility removing all areas of black and gray with blue fuzzy spots, including under kitchen sink. Facility to submit work order and paid invoice of professional pest exterminator, showing facility has been treated for rodents
	8 9 10 11 12 13 14	droppings, decomposed rodent with skeletal remains in tact, cracks in walls and ceilings, flooring that bows under walking weight, cabinet under sink to have black substance present, black substance with fuzzy gray and blue spots present in areas of wall that has holes by laundry dryer, 20-30 flies present in dining area and living area off kitchen, which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	Facility to submit plan of how to minimize flies in common areas, and submit proof of purchase for any items indentified in plan by plan of correction due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260313093610

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: GILCREST GROUP HOME, THE	FACILITY NUMBER: 480111090
	VISIT DATE: 03/18/2026

NARRATIVE

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Continued from 9099C...

Pipes visible.

LPA observed rodent dropping in closet in living area off kitchen. Additionally, there was a fully decomposed rodent of which the skeletal remains were present and in tact. Cigarette butts present all throughout facility, in bedrooms, living areas, on chairs, and on tables.

Based on LPA’s observations the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, are being cited on the attached 9099D. Exit interview conducted over phone with Administrator and report signed by caregiver. Appeal rights given and discussed.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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