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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801381
Report Date: 06/12/2020
Date Signed: 06/15/2020 02:08:38 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2019 and conducted by Evaluator Christopher Arnhold
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20191014134719
FACILITY NAME:ALMABELLA MANORFACILITY NUMBER:
486801381
ADMINISTRATOR:GUBA, ALMABELLAFACILITY TYPE:
740
ADDRESS:3323 TENNESSEE ST.TELEPHONE:
(707) 645-7389
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: DATE:
06/12/2020
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Almabella GubaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal eviction

Provider is sharing resident's private information with a person other than the responsible party
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 10:55am, Licensing Program Analyst (LPA) Chris Arnhold contacted Almabella Guba via telephone to deliver findings regarding this complaint. This Telephone visit is due to Covid-19 restrictions. Based on interviews with Almabella, R1 was not issued an eviction. R1 moved from the facility in December, due to lack of financial resources to continue. This descision was made by R1, without influence or direction from Almabella. Documentation showed R1 was their own responsible party and handled their own finances. Based on records reviewed and interviews conducted, Almabella did not share private information to anyone without the consent of R1.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated. No citations issued
Original signature on file.
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: 06/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2020
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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