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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801728
Report Date: 01/08/2026
Date Signed: 01/08/2026 11:00:25 AM

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
10/08/2025 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20251008190638
FACILITY NAME:GLAJAN CARE, INC.FACILITY NUMBER:
486801728
ADMINISTRATOR:MILES, GLADYSFACILITY TYPE:
735
ADDRESS:163 DEVONSHIRE ST.TELEPHONE:
(707) 656-6012
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: 2DATE:
01/08/2026
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:CaregiverTIME COMPLETED:
11:15 PM
ALLEGATION(S):
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Questionable death.
INVESTIGATION FINDINGS:
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On 1/8/26 Licensing Program Analyst (LPA) Coppo arrived unannounced to deliver findings for a Complaint regarding the above allegation and met with caregiver. Administrative Assistant Keith Cooper was reached by phone and gave caregiver permission to sign report.. During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations.

The complaint alleges questionable death. On 9/26/2025, Client (C1) became unresponsive while being bathed. During the bath, C1 attempted to ingest water claiming to be thirsty which was not unusual behavior for C1. While C1 was being dressed after the bath, Staff (S1) noted some water and bubbles coming out of C1’s mouth. C1 then became limp and unresponsive. 911 was called and when Emergency Medical Services (EMS) arrived, it was noted that C1 was pulseless. CPR was initiated and

Continued on 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
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 2
Control Number 21-AS-20251008190638
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: GLAJAN CARE, INC.
FACILITY NUMBER: 486801728
VISIT DATE: 01/08/2026
NARRATIVE
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Continued from 9099...

C1 was able to regain a pulse. It was determined that C1 had been in cardiac arrest for approximately 25 to 30 minutes prior to regaining a pulse. Although there was a concern of drowning upon EMS arrival, there was no evidence of trauma nor any information documented in the hospital records to indicate any additional significant conditions contributing to the death of C1. C1 passed away in the hospital on 10/7/2025. The Solano County Coroner’s office did not conduct an autopsy of C1. On C1’s death certificate the immediate cause of death was pulseless electrical activity arrest.


Although the allegation may be true, or valid, based upon observations, statements, and records, there is not a preponderance of evidence to prove the allegation is, or is not true. Therefore, allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2