<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496804141
Report Date: 05/05/2026
Date Signed: 05/05/2026 11:22:49 AM

Document Has Been Signed on 05/05/2026 11:22 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:
05/05/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:38 AM
MET WITH:Anton Kuehnhackl (Licensee)TIME VISIT/
INSPECTION COMPLETED:
11:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee, Anton Kuehnhackl. Annual fees are current. Required postings were observed. The facility has approval for two clients receiving hospice, but there are no clients receiving hospice services. The facility does not handle cash resources. Contact information was reviewed.

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 108.9 degrees 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 February 2026. Smoke detectors throughout the facility and carbon monoxide detector were tested and operational. Facility has smoke detectors and sprinklers. Most recent disaster drill was conducted January 13, 2026.

LPA initiated file review at approximately 9:00am. Two staff and three client files were reviewed. Residents have individualized care plans updated. Staff records indicated that CPR/1st aid and staff have received required annual training hours. Administrator Certificate for Rudolf A. Kuehnhackl, 7015460735 expires 03/12/28. Medication and medication records were reviewed.
Continued on LIC809C...
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: MILLS MANOR
FACILITY NUMBER: 496804141
VISIT DATE: 05/05/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC809...

At approximately 9:30am, during file review, LPA/Licensee observed that client (C1) has a non-ambulatory status in their physician's report, but C1 was observed walking around the facility without any ambulation challenge, so LPA inquired with Administrator and it was determined that this discrepancy needs to be addressed with their physician to change the ambulatory status. The facility has an approved fire clearance dated 5/30/23 for the facility allowing two non-ambulatory clients. Also, C1 is now over 60 years old, but administrator stated that their needs are still compatible with the other clients in care and they do not require any higher level of care. Based on quarterly nurse evaluation dated December 2025, C1 is still continent, but requires 24 hour supervision, which according to administrator, the facility is able to meet C1's care and supervision needs. However, C1's file does not contain a current physician report (LIC602) made within the last year and administrator agreed to obtain required documentation including a letter of support from C1's conservator documenting that the facility is the most appropriate setting for C1. Also, client (C2) has an ambulatory status on their physician report dated 2018, but C2 is non-ambulatory and uses a wheelchair. LPA/Licensee discussed the issue with C1 and C2 and agreed that they need to contact both physicians to obtain an updated physician's report (LIC602). Additionally, C2 does have half bed rails, but Licensee was unable to locate doctor's order and provided service agreement from Kaiser indicating the use of hospital bed with half bed rails (technical violation was issued).

Licensee agreed to submit the following documents by 5/19/26: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and surety bond.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency &/or repeat deficiencies within a 12 month period may result in civil penalties.
Exit interview conducted with Licensee and copy of report was given.
NAME OF LICENSING PROGRAM MANAGER: Bethany Moellers
NAME OF LICENSING PROGRAM ANALYST: Marisol Cuadra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/05/2026 11:22 AM - It Cannot Be Edited


Created By: Marisol Cuadra On 05/05/2026 at 11:05 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: MILLS MANOR
FACILITY NUMBER: 496804141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85068.4(e)
Acceptance and Retention Limitations
(e) The licensee shall ensure that the medical assessment for each client 60 years of age or older is updated at least annually and in accordance with the regulations addressing medical assessments in Residential Care Facilities for the Elderly (RCFE) [California Code of Regulations, Title 22, Sections 87458(b) and (c)].

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's/Admin observation, interviews and record review, the licensee did not comply with the section cited above in C1 who is 60 years old did not have a current physician's report, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2026
Plan of Correction
1
2
3
4
Licensee agrees to obtain and submit current physician's report for C1 by plan of correction due date.
Type B
Section Cited
CCR
80069(c)(4)
Client Medical Assessments
(c) The medical assessment shall include the following: (4) A determination of the client's ambulatory status, as defined by Section 80001(n)(2).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's/Licensee observation, interview and record review, the licensee did not comply with the section cited above in two out of three clients did not have a clear determination of client's ambulatory status which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/19/2026
Plan of Correction
1
2
3
4
Licensee agrees to obtain and submit current physician's report for C1 and C2 by plan of correction due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Bethany Moellers
NAME OF LICENSING PROGRAM MANAGER:
Marisol Cuadra
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5