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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486801443
Report Date: 02/12/2026
Date Signed: 02/12/2026 01:42:45 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 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
11/21/2025 and conducted by Evaluator Ethel Contreras
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20251121143502
FACILITY NAME:MASONIC GUEST HOMEFACILITY NUMBER:
486801443
ADMINISTRATOR:LACAP, LEONIDAFACILITY TYPE:
740
ADDRESS:310 MASONIC DR.TELEPHONE:
(707) 563-5039
CITY:VALLEJOSTATE: ZIP CODE:
94591
CAPACITY:6CENSUS: 5DATE:
02/12/2026
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Leonida Lacap-AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Ethel Contreras arrived at this facility unannounced to conduct an investigation into the above allegation and deliver complaint findings. LPA was greeted by adminsitrator Leonida Lacap.

Complaint alleges Personal Rights. Complainant alleges that R1 was struck on the hand as a corrective measure by facility staff. During investigation LPA conducted interviews. 4 out of 4 resident report they have never been hit, slapped, or struck by facility staff. Additionally, all residents interviewed report they have never seen facility staff hit any other residents. LPA also interviewed facility staff. Staff interviewed report they have never hit, slapped, or struck any residents and they have never seen any other staff hit, slap, or strike any residents. So, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Copy of report given and read with administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Ethel Contreras
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026
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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