236801775-8-24-2023-21-AS-BMOS-CWNNGK-20231016102715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 236801775
Report Date: 08/24/2023
Date Signed: 08/24/2023 02:44:09 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
07/12/2023 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20230712160011

FACILITY NAME:	EQUINOX CARE FACILITY LLC		FACILITY NUMBER:	236801775
ADMINISTRATOR:	AJEL, AGNES		FACILITY TYPE:	740
ADDRESS:	38281 S HWY 1		TELEPHONE:	(707) 884-4061
CITY:	GUALALA	STATE: CA	ZIP CODE:	95445
CAPACITY:	9	CENSUS: 5	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Agnes Ajel		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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9

Lack of Care & Supervision

INVESTIGATION FINDINGS:

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At approximately 12:15PM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to deliver investigative findings for the above allegation. LPA met with Administrator Agnes Ajel. Based on interviews conducted and a review of records, LPA was not able to determine that staff did not provide care or supervision. LPA reviewed staffing records and observed there to be staff present with an additional staff available on call at all times. LPA spoke with residents regarding the care received. Residents told LPA they always receive assistance when they ask for it.
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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher Arnhold	TELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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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