486804161-10-1-2026-21-AS-VBEI-DYNTQ6-20261008145524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804161
Report Date: 10/01/2026
Date Signed: 10/01/2026 02:17:39 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
09/09/2026 and conducted by Evaluator Elias Magdaleno

COMPLAINT CONTROL NUMBER: 21-AS-20260909135255

FACILITY NAME:	VINA DEL MAR ASSISTED LIVING AND MEMORY CARE		FACILITY NUMBER:	486804161
ADMINISTRATOR:	CLEEK, JEREMY		FACILITY TYPE:	740
ADDRESS:	105 POWER DRIVE		TELEPHONE:	(707) 343-9352
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94589
CAPACITY:	68	CENSUS: 44	DATE:	10/01/2026
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Jocela Ayson, Resident Care Coordinator		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Personal Rights
Staff did not secure resident's personal belongings
Facility did not meet resident's hygiene needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magdaleno arrived unannounced to deliver findings regarding the above allegations and met with Resident Care Coordinator Jocela Ayson.

During the course of this investigation LPA made observations, reviewed documents, and conducted interviews.

Personal Rights – Reporting Party (RP) alleges that they were harassed, recorded, and followed by staff while visiting resident (R1). During further interviews, RP alleged that while attempting to spend time with R1 they were both treated rudely by staff and threatened with police action.Interviews with management indicated that RP came to the facility without informing staff who they were visiting, was not on R1s list of family, and was rude to staff.
Continued LIC9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026

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-20260909135255

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: VINA DEL MAR ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 486804161
	VISIT DATE: 10/01/2026

NARRATIVE

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Continued from LIC9099...

Management also indicated that RP threw an object at a staff member prompting management to ask RP to leave the premises. Further interviews with management indicated this resulted in the RP becoming aggressive, recording staff, and the police was called. Interview with staff (S3) indicated they were assisting RP when RP threw an object at them and S3 immediately informed management. Interview with staff (S1) indicated they were asked to record the interaction between RP and management in case of escalation. Interview with staff (S2) indicated they were with residents participating in activities at the time and residents became agitated at RP’s yelling causing staff to redirect them. Review of videos submitted indicated that staff requested RP to leave the facility in a calm manner, when the situation escalated staff removed R1 in order to maintain their safety. Further review of videos indicated facility staff continued to ensure resident safety while waiting for police response. Review of police report indicated police response and RP was asked to leave the facility. Interview with Administrator indicated they were asked if they wished to sign a trespassing charge and Administrator declined.

Staff did not secure resident's personal belongings – RP alleges that facility was not able to account for R1s belongings after moving resident to a new room. Interviews with management indicated that R1 has not moved rooms in at least three (3) years. Interview with RP indicated that R1 was wearing another resident’s hat and facility could not produce R1’s newly purchased hat. Review of submitted videos indicated RP was asking staff for R1’s new hat and stating that R1 was not wearing their own hat. Interviews with staff indicated that R1 was wearing the same hat they always wear, and that a new hat had just arrived and was still in the shipping package in R1’s room. Review of photographs submitted indicated that R1’s hat was delivered to the facility and was in R1’s room in it's shipping package. Further interviews with management indicated that RP requested to enter other residents’ rooms to search for alleged missing items but was not allowed in order to maintain privacy for other residents. Interview with Power of Attorney (POA) indicated they do not believe R1 has moved rooms and remains in the same room they have always had. Further interviews with POA indicated they are not aware of R1 having had any property lost.

Continued LIC9099C...

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026

LIC9099 (FAS) - (06/04)

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Control Number 21-AS-20260909135255

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: VINA DEL MAR ASSISTED LIVING AND MEMORY CARE	FACILITY NUMBER: 486804161
	VISIT DATE: 10/01/2026

NARRATIVE

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Continued from LIC9099C...

Facility did not meet resident's hygiene needs – RP alleges that facility is not providing proper hair care based on R1’s cultural heritage, which includes showering and wetting R1’s hair too often. Interviews with management indicated that R1 is unable to bathe on their own and receives bed baths, not showers. Review of Care Plan indicated that R1 requires a 2-person assist with bathing which includes bed baths twice a week. Interview with POA indicated that they are consulted by the facility regarding R1s care plan and have agreed to what is written on the care plan. Further interviews with POA indicated that numerous family members have visited R1 regularly and have not reported any concerns. POA stated their only request is for R1 to wear a shower cap if showered.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies cited. Exit interview conducted with Resident Care Coordinator, whose signature on form confirms receipt.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026

LIC9099 (FAS) - (06/04)

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