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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 121373153
Report Date: 05/13/2024
Date Signed: 05/13/2024 01:50:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/28/2024 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20240228134417
FACILITY NAME:AGUILAR MANORFACILITY NUMBER:
121373153
ADMINISTRATOR:AGUILAR, STIIVIFACILITY TYPE:
740
ADDRESS:6433 EGGERT ROADTELEPHONE:
(707) 443-5160
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:15CENSUS: 11DATE:
05/13/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Stiivi AguilarTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff does not ensure adaquite care and supervision is provided to residents in care
Staff did not ensure reporting requirements were followed
Staff mismanages residents cash resources for goods and personal items
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct an investigation into the above allegations. LPA met with Administrator Stiivi Aguilar, reviewed records and interviewed staff. Based on interviews conducted and records reviewed, LPA was not able to find evidence to support the allegation that staff did not ensure adaquite care and supervision. Records reviewed showed R1 was able to be in the community without assistance and staff were aware resident was away from the home. Based on records reviewed, facility notified CCLD and other responsible parties within timelines of Title 22. Based on records reviewed and interviews conducted, LPA learned facility does not handle resident cash resources. LPA reviewed facility procedures for handling resident finances. A resident is payed monthly and facility takes residents to the bank to cash their checks. Continued on LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
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-20240228134417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: AGUILAR MANOR
FACILITY NUMBER: 121373153
VISIT DATE: 05/13/2024
NARRATIVE
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Facility receives resident checks in the mail and safeguards them until a trip to the bank is made. Once checks are cashed, residents handle their own finances.

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.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2