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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336411257
Report Date: 04/18/2026
Date Signed: 04/18/2026 02:48:22 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2023 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230919095745
FACILITY NAME:AGATE MANORFACILITY NUMBER:
336411257
ADMINISTRATOR:MARIANA MIHAILOVICIFACILITY TYPE:
740
ADDRESS:33391 AGATE STTELEPHONE:
(951) 672-2595
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:6CENSUS: 3DATE:
04/18/2026
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Mariana MihailoviciTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are interfering with the residents medical decision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Licensee Mariana Mihailovici who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 09/27/2023, LPA Janira Arreola conducted an unannounced visit to the facility in order to investigate the above allegation. During the visit, LPA conducted interviews and conducted records reviews. LPA advised the licensee on records that would need to be sent to the LPA. At the time the allegations required further investigation. During today’s visit, LPA Gutierrez obtained staff roster, resident roster, reviewed six (6) residents files, interviewed Licensee, staff #1- (S1), residents 1-3 (R1-R3), telephone interviews with witness #1-witness #2 (W1-W2) and attempted interviews with witness #3- witness #6 (W3-W6). LPA delivered findings.

SEE LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20230919095745
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AGATE MANOR
FACILITY NUMBER: 336411257
VISIT DATE: 04/18/2026
NARRATIVE
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In regard to the allegation” Staff are interfering with the resident’s medical decision”, It is alleged that facility forces their residents to choose one specific hospice agency not offering any choices to their residents. During interview with Licensee, and staff both stated that they never make medical decisions for residents, all family or responsible parties are notified. Licensee stated that they make suggestions but ultimately, it’s the family’s choice on what agency they want to go with. Licensee stated that facility does not use mentioned hospice care agency that is listed on report. LPA reviewed three (3) current residents files and three (3) former resident files all who received hospice care at one time at facility and six (6) out of six (6) were never using mentioned hospice care agency on report. LPA interviewed two (2) witnesses over the telephone. W1 stated that they had a previous hospice agency that was not very good and they switched to a better agency. W1 stated facility never pressured them into making a choice for what agency they used. W2 stated they did feel a little bit of pressure in choosing there hospice agency but stated maybe it’s easier for facility to have one agency. During interviews with residents, one (1) out of three (3) stated family is in charge of medical decisions and not staff, one (1) resident stated that hospital is in charge of medical decisions, and one (1) resident did not answer LPA.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted with Licensee, and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2026
LIC9099 (FAS) - (06/04)
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