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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486830735
Report Date: 09/15/2026
Date Signed: 09/15/2026 02:23:26 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
06/19/2026 and conducted by Evaluator Ethel Contreras
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260619152811
FACILITY NAME:VACA VALLEY LIVING A MEMORY CARE COMMUNITYFACILITY NUMBER:
486830735
ADMINISTRATOR:JAMIE HEALERFACILITY TYPE:
740
ADDRESS:80 ORANGE TREE CIRCLETELEPHONE:
(707) 724-6751
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:60CENSUS: 34DATE:
09/15/2026
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jaime Healer-Administrator TIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Staff does not ensure prompt communication with residents personal representatives is being provided
Licensee does not ensure staff are in good mental health to perform assigned tasks
Staff allow residents to be left in soiled clothing for extended periods of time due to neglect
Staff do not ensure adequate wound care is provided to residents due to neglect
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Contreras arrived unannounced for the purpose of delivering complaint findings to the above allegations. During the course of the investigation, LPA conducted interviews, made observations and collected documents.

Reporting Party( RP) alleges staff does not ensure prompt communication with residents personal representatives is being provided. Based on interviews, facility provides communication policy including packet with phone numbers for line of communication. In addition, when there is a resident change in care, it is communicated with the POA or family and communication is documented. Due to lack of information given by RP, there is no evidence to show facility is not ensuring prompt communication. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

continued onto 9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
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-20260619152811
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: VACA VALLEY LIVING A MEMORY CARE COMMUNITY
FACILITY NUMBER: 486830735
VISIT DATE: 09/15/2026
NARRATIVE
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continued from 9099....

Allegation licensee does not ensure staff are in good mental health to assign tasks, based on LPA observation and interview, there was no indication or signs that staff are in poor mental health. Six out of six staff interviews and interactions expressed no personal distress or inability to manage tasks. Based on observation, all staff members were cooperative and fully oriented to their assigned duties. A file review of LIC503 Health Screening of active staff was completed and did not indicate any physical or mental restrictions to perform their assigned duties. In addition, there has been a total of five new hires in facility. Based on file review and observation, there is no indication that facility has staffing concerns. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation, staff allow residents to be left in soiled clothing for extended periods of time due to neglect. Based on health and safety walk through conducted by LPA, LPA did not observe any residents in soiled clothing including odorous smells inside rooms and throughout the facility on separate facility visits. Based on interviews, five out of five staff stated resident room checks are conducted every two hours and bedding is changed daily. Based on resident interviews, four out of four residents stated that they did not have concerns with rooms or not being provided with proper hygiene care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Allegation staff do not ensure adequate wound care is being provided to residents due to neglect, based on file review and interview, wound care is being regularly conducted and is administered by Hospice not facility. Based on interview, wound care is followed based on Hospice care plan and facility conducts resident hospice checks every hour. LPA conducted a room check in all wound care residents and did not observe signs of wound care neglect. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies cited during today’s visit.

Copy of report given and read with administrator.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2