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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804141
Report Date: 05/07/2024
Date Signed: 05/07/2024 10:56:15 AM

Document Has Been Signed on 05/07/2024 10:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MILLS MANORFACILITY NUMBER:
496804141
ADMINISTRATOR/
DIRECTOR:
KUEHNHACKL, ANTONFACILITY TYPE:
735
ADDRESS:9790 OCONNELL RDTELEPHONE:
(707) 824-8403
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 6CENSUS: 3DATE:
05/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:31 AM
MET WITH:Anto Kuehnhackl (Licensee/Administrator)TIME VISIT/
INSPECTION COMPLETED:
11:11 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee, Anton Kuehnhackl. Clients were attending to day program.

LPA/Licensee initiated a tour of the facility and made the following observations: Facility was a comfortable temperature and passageways were free from obstruction. Client bedrooms were furnished per regulation. Water temperatures in bathrooms ranged from 114.8 and 110.3 F which is within regulation. Extra linens and hygiene products were available. At least two days of perishable and one week of non-perishable food was available. Toxins were inspected and are locked in a cabinet in the laundry room. Medications are centrally stored in a locked closet in the dining room. Fire extinguisher was last inspected January 2024. Smoke detectors throughout the facility and carbon monoxide detector were tested and operational. Facility has smoke detectors and sprinklers. Fire panel was last inspected 11/6/23. Most recent disaster drill was conducted April 15, 2024. The facility does not handle cash resources. Required postings were observed.

LPA initiated file review at approximately 9:00am. Two staff and three client files were reviewed. Residents have medical assessments and individualized care plans. Staff records indicated that CPR/1st aid and staff have received required annual training hours. Administrator Certificate for Rudolf A. Kuehnhackl, 6021507735 expires 12/7/24. Medication and their records were reviewed.

Licensee agreed to submit the following documents by 5/13/24: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Emergency disaster plan (if there are any changes LIC610E).

No deficiencies cited during this inspection. Exit interview conducted with Licensee and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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