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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 216804010
Report Date: 08/24/2026
Date Signed: 08/24/2026 04:50:26 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
07/08/2026 and conducted by Evaluator Caitlynn Felias
COMPLAINT CONTROL NUMBER: 21-AS-20260708122653
FACILITY NAME:VINCENT, THEFACILITY NUMBER:
216804010
ADMINISTRATOR:CORTES, MARIAFACILITY TYPE:
740
ADDRESS:1 LAS GALLINAS AVETELEPHONE:
(628) 336-1400
CITY:SAN RAFAELSTATE: CAZIP CODE:
94903
CAPACITY:126CENSUS: 81DATE:
08/24/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director, Maria CortesTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Due to lack of supervision, resident pushed another resident
INVESTIGATION FINDINGS:
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At approximately 9:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to deliver findings for 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 and made observations. The following allegation was investigated, "Due to lack of supervision, resident pushed another resident.” Complaint alleged that during a resident outing on 06/21/2026, Resident 1 (R1) stated that while on the bus, they were pushed by Resident 2 (R2). Report stated that R2 pushed R1 and caused them to stumble.

Review of R1's file showed that they did not have a diagnosis of mild cognitive impairment (MCI) or major neurocognitive disorder such as dementia. Review of R1’s care plan dated 09/16/2025 and 07/14/2026, showed that R1 did not require one-on-one supervision. Review of R2’s file showed that they did not have a 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 2
Control Number 21-AS-20260708122653
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

diagnosis of MCI or major neurocognitive disorder such as dementia. R2’s care plan dated 09/18/2025, showed that R2 did not require one-on-one supervision. Both R1 and R2’s care plans also stated that they did not have a history of disruptive, aggressive, verbal, or socially inappropriate behavior.

SOC341 report submitted by the facility on 06/24/2026 was reviewed. Report stated that on 06/21/2026, R1 reported that they were pushed by R2 during their resident outing. Per report, R1 did not sustain any injuries during the incident.

Police report dated 06/30/2026 stated that the San Rafael Police Department (SRPD) also investigated the incident. Per report, they closed their case as both residents involved sustained no injuries and their responsible parties were notified.

Based on record review, and observations made, this allegation is 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 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)
Page: 2 of 2