585002583-9-11-2025-59-AS-TORZ-DLRP8V-20250922110611

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 585002583
Report Date: 09/11/2025
Date Signed: 09/11/2025 01:01:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2025 and conducted by Evaluator Kerry Hiratsuka

COMPLAINT CONTROL NUMBER: 59-AS-20250617081048

FACILITY NAME:	AGATI HOME CARE		FACILITY NUMBER:	585002583
ADMINISTRATOR:	AGATI, AZUCENA		FACILITY TYPE:	735
ADDRESS:	5554 MEADOW BROOK WAY		TELEPHONE:	(530) 741-1434
CITY:	MARYSVILLE	STATE: CA	ZIP CODE:	95901
CAPACITY:	4	CENSUS: 4	DATE:	09/11/2025
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Mae Katz		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff handled client in a rough manner
Staff threatened client

INVESTIGATION FINDINGS:

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Licensing Program Analyst LPA Hiratsuka conducted the investigation into the allegations above.

LPA Hiratsuka conducted interviews and reviewed resident file.

One person stated the Caregiver attempted to pull the resident from a vehicle and verbally threatened the resident. LPA attempted to interview the resident and the resident refused. Caregiver denied the allegation and stated she was trying to assist the resident from getting out a vehicle and when the resident refused Caregiver stated she walked way from the resident. Several interviews stated the resident is known to refuse to do things and has a history of refusing to get out of vehicles. Because the resident refused to speak to LPA, LPA cannot prove or disprove the allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

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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