486803645-10-15-2026-21-AS-VBEI-DZ432S-20261021175226

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803645
Report Date: 10/09/2026
Date Signed: 10/15/2026 03:22:59 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
07/13/2026 and conducted by Evaluator Ali Deniz

COMPLAINT CONTROL NUMBER: 21-AS-20260713104822

FACILITY NAME:	VACAVILLE MEMORY CARE		FACILITY NUMBER:	486803645
ADMINISTRATOR:	CAMILLE BROWN		FACILITY TYPE:	740
ADDRESS:	431 NUT TREE ROAD		TELEPHONE:	(707) 449-1350
CITY:	VACAVILLE	STATE: CA	ZIP CODE:	95687
CAPACITY:	75	CENSUS: 37	DATE:	10/09/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director, Camille Brown		TIME COMPLETED:	02:06 PM

ALLEGATION(S):

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Staff did not properly supervise residents, resulting in a resident being physically assaulted.
Staff did not meet resident’s care needs.
Staff did not assist with making resident’s medical appointments.
Staff yelled at resident.
Facility's air conditioner is in disrepair.

INVESTIGATION FINDINGS:

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At approximately XX:XX AM/PM, Licensing Program Analyst (LPA) Ali Deniz arrived unannounced to deliver findings for a complaint investigation regarding the above allegationS and met with Executive Director, Camille Brown.
During the course of the investigation, the Department conducted interviews, reviewed documents, and made observations. The following allegations were investigated: “Staff did not properly supervise residents, resulting in a resident being physically assaulted. Staff did not meet resident’s care needs. Staff did not assist with making resident’s medical appointments. Staff yelled at resident. Facility's air conditioner is in disrepair.”

“Staff did not properly supervise residents, resulting in a resident being physically assaulted” – The complaint alleged that staff did not properly supervise residents, resulting in R1 being physically assaulted by R2. The RP reported that R2 had been involved in multiple incidents with R1, including an incident in which R2 allegedly struck R1 and caused R1 to lose consciousness.
Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2026

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-20260713104822

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: 10/09/2026

NARRATIVE

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Continued from LIC9099 page...

During the investigation, LPA interviewed S1 and reviewed the facility’s SOC 341 submitted to Community Care Licensing on 03/30/2026. S1 reported that staff immediately intervened, separated R1 and R2, and contacted 911 for further evaluation. The SOC 341 documented that R2 struck R1 twice on the back of the head. Staff separated the residents, management assisted with de-escalation, and R1 was relocated to another house to prevent further conflict.
Based on interviews conducted and documents reviewed, there was insufficient evidence to establish that staff failed to properly supervise the residents or respond appropriately to the incident. Therefore, this allegation is Unsubstantiated.
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“Staff did not meet resident’s care needs” - The complaint alleged that staff did not meet R1’s care needs and that R1 required one-to-one supervision. The RP reported that R1’s family requested one-to-one care for R1 and believed the facility was not meeting R1’s care needs.
During the investigation, LPA reviewed R1’s medical assessment and facility staffing information. Records indicated that R1 was not assessed as requiring one-to-one supervision. LPA also reviewed the facility’s staffing ratio and found that staffing was maintained in accordance with applicable Title 22 requirements.
Based on records reviewed and information obtained during the investigation, there was insufficient evidence to establish that the facility failed to meet R1’s assessed care needs. Therefore, this allegation is Unsubstantiated.
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“Staff did not assist with making resident’s medical appointments” - The complaint alleged that staff did not assist with scheduling R1’s medical appointments, specifically a podiatry appointment for nail care. The RP reported that the family had previously arranged for a podiatrist to provide services to R1 at the facility.
During the investigation, LPA reviewed R1’s admission agreement and interviewed S1. S1 reported that a podiatrist visits the facility approximately every two months by appointment. S1 further stated that routine fingernail and toenail care is generally arranged by the resident’s family or responsible party.
Based on the records reviewed and information obtained during the investigation, there was insufficient evidence to establish that the facility failed to assist R1 with medical appointments. Therefore, this allegation is Unsubstantiated.
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Continued on LIC9099-C page...

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 21-AS-20260713104822

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: 10/09/2026

NARRATIVE

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Continued from LIC9099-C page...

“Staff yelled at resident” - The complaint alleged that staff yelled at R1 and that a staff member was heard yelling at R1 during a shower.
During the investigation, LPA interviewed facility staff regarding the allegation. Staff reported that they had not witnessed or received any reports of staff yelling at, or being rough with, R1 or other residents. No additional information or documentation was obtained to corroborate the allegation.
Based on interviews conducted and information obtained during the investigation, there was insufficient evidence to establish that staff yelled at R1. Therefore, this allegation is Unsubstantiated.
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"Facility's air conditioner is in disrepair"- The complaint alleged that the facility’s air conditioning system had been inoperable for approximately three months.
During facility visits on 07/16/2026 and 08/05/2026, LPA observed that the central air conditioning system in Wheatley House was not fully operational. The ED reported that the facility was awaiting a repair estimate and had purchased a portable air conditioning unit. LPA observed the thermostat reading 79°F, and the ED reported that resident bedrooms were equipped with portable fans.

Based on LPA’s observations and information obtained, the air conditioning system was in disrepair; however, there was insufficient evidence to establish a violation of Title 22 regulations. Therefore, this allegation is Unsubstantiated.

Based on interviews conducted, documents gathered these allegations are Unsubstantiated. A finding that the 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 Executive Director. Signature on form confirms receipt of documents.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2026

LIC9099 (FAS) - (06/04)

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