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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 07/16/2026
Date Signed: 07/16/2026 03:02:35 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
04/06/2026 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20260406103215
FACILITY NAME:VACAVILLE MEMORY CAREFACILITY NUMBER:
486803645
ADMINISTRATOR:CAMILLE BROWNFACILITY TYPE:
740
ADDRESS:431 NUT TREE ROADTELEPHONE:
(707) 449-1350
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:75CENSUS: 48DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Executive Director, Camille BrownTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff left residents unattended.
Lack of staff supervision resulting in resident eloping from the facility.
INVESTIGATION FINDINGS:
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At approximately 09:30AM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to continue a complaint Investigation and delivered the findings regarding the above allegations and met with Executive Director, Camille Brown.

During the course of the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegations were investigated, “Staff left residents unattended and Lack of staff supervision resulting in resident eloping from the facility.”

The complaint alleged that the facility left residents unattended and failed to provide adequate staff supervision, resulting in Resident 1 (R1) eloping from the facility during the night shift.
LPA conducted an unannounced complaint investigation, interviewed the Executive Director and staff, reviewed facility records, including care notes and the incident report, and toured the facility.
Continued on LIC9099-C page...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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-20260406103215
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: 07/16/2026
NARRATIVE
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Continued from LIC9099 page...

Interviews revealed that while the designated caregiver was on a scheduled break, a Medication Technician remained in the facility to provide resident supervision. Staff reported that R1 was found outside Journey House but remained within the facility's secured grounds and did not exit the locked perimeter gate. The Executive Director stated that residents are permitted to access the secured courtyard during the night shift and confirmed that R1 did not have a physician's order requiring one-to-one supervision. LPA's review of records did not reveal any prior elopement by R1.

Based on interviews, observations, and records reviewed, there is insufficient evidence to support the allegation that the facility left residents unattended or that inadequate staff supervision resulted in R1 eloping from the facility.

Therefore, this allegation is Unsubstantiated. A finding of Unsubstantiated means that although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

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: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2