Agate Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Imaculada Vasquez arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose with Licensee, Mariana Mihailovici. Resident record review began- Two (2) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility meets documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 120.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap in the laundry room and other chemicals. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location (951) 672-2595. Food Service- Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables food on hand. Foods are dated to assure safety. Food prep areas are clean and organized. (Continued on next page) (Continued from Page 1) LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee records for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current, expires on 06/09/2026. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Two (2) Fire extinguishers are replaced annually and were last done so on 09/20/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 04/02/2026. During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee.the state’s words, verbatim · CDSS document, Apr 21, 2026

Allegation investigated: Staff are interfering with the residents medical decision

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 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.the state’s words, verbatim · CDSS document, Apr 18, 2026 · control 18-AS-20230919095745

Type of visit: Required - 1 Year

On 5/16/2024 Licensing Program Analysts (LPAs) Janette Romero and Valerie Flores conducted an unannounced annual required visit. LPAs met with Licensee, Mariana Mihailovici who was informed of the purpose of the visit. The facility is licensed to care for six (6) non-ambulatory residents of which three (3) may be bedridden. The facility currently has a total of four (4) residents for which two (2) are receiving hospice care and one (1) is receiving home health services at the facility. Staff present have a criminal record clearance and are associated to the facility. LPAs conducted a tour of the facility with Licensee. Indoor and outdoor passageways are free of obstructions. There are no bodies of water. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. LPAs observed a second refrigerator with perishable foods and emergency food and water stored in the garage. Resident bedrooms had the required bedding, furniture, and lighting. Resident bathrooms had grab bars and non-skid mats in the showers. Disinfectants and cleaning solutions were secured in the locked laundry room. Licensee tested one of the carbon monoxide/smoke detectors and LPAs observed it to be operational. LPAs observed charged fire extinguishers mounted throughout the facility. The facility has door alarms as a safety measure to identify wandering behaviors and LPAs were informed that none of the current residents display wandering behaviors. LPAs reviewed the medication administration record along with the physical medications for two (2) residents and did not discover any discrepancies. LPAs also reviewed random staff and resident files. Staff files reviewed have a criminal record clearance and valid first aid/CPR certification. Resident files review have signed admission agreements and updated physician reports. Facility sketch and Long-Term Care Ombudsman's information is posted near the entrance and living room. During today's visit, LPAs did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee.the state’s words, verbatim · CDSS document, May 16, 2024