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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 236803819
Report Date: 03/24/2022
Date Signed: 03/24/2022 09:15:19 AM

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
02/04/2022 and conducted by Evaluator Christopher Arnhold
COMPLAINT CONTROL NUMBER: 21-AS-20220204102539
FACILITY NAME:VICTORIA MANORFACILITY NUMBER:
236803819
ADMINISTRATOR:REYES, VICTORIAFACILITY TYPE:
740
ADDRESS:419 GROVE STTELEPHONE:
(707) 456-1234
CITY:WILLITSSTATE: CAZIP CODE:
95490
CAPACITY:6CENSUS: DATE:
03/24/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Victoria ReyesTIME COMPLETED:
09:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff does not answer the phone
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to deliver findings for the above allegation. LPA met with Administrator Victoria Reyes. Based on interviews conducted and observation, the allegation that facility staff does not answer the phone is unsubstantiated. During LPA's visit on 02/11/2022, LPA observed facility staff answer the phone on several occasions. Administrator explained to LPA that there are times a resident may be on the phone and does not understand what the call waiting beep means, and the call would not be answered. There are other times staff may be assisting a resident and unable to answer. Administrator told LPA they answer the phone as often as possible.
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. No citations issued during this visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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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