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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803090
Report Date: 06/05/2025
Date Signed: 06/05/2025 03:28:14 PM

Substantiated


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
06/03/2025 and conducted by Evaluator Anthony Loera
COMPLAINT CONTROL NUMBER: 21-AS-20250603093211
FACILITY NAME:ELANA BOARD AND CAREFACILITY NUMBER:
486803090
ADMINISTRATOR:CARTEL, JULLYFACILITY TYPE:
740
ADDRESS:236 CLYDESDALE AVETELEPHONE:
(707) 563-5252
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:6CENSUS: 5DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jully Cartel, AdministratorTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff did not provide a refund to authorized representative
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Loera conducted a complaint investigation regarding the above allegation. LPA reviewed resident and facility records and interviewed Administrator. Resident (R1) had passed away on 01/22/2025. According to the admission agreement, licensee agrees to refund any fees within 15 days paid in advance covering the time after the residents items have been removed. LPA was informed by administrator that R1's personal belongings were removed from the room on 01/24/2025, therefore the refund would start from 01/25/2025 through 01/31/2025. A total amount due for a refund is calculated for 7 days. Facility has paid a refund amount of approximately 5 days. A balance is still due to be paid to responsible party/authorized representative for the remaining days.

The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Appeal Rights were given to the Administrator
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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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Control Number 21-AS-20250603093211
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: ELANA BOARD AND CARE
FACILITY NUMBER: 486803090
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2025
Section Cited
HSC
1569.652
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1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds.
This requirement was not met as evidenced by***
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Licensee to refund remaining fee's paid to residents responsible party. In addition, Licensee to submit a written plan of future compliance regarding this regulation ensuring that due refunds are provided within regulation and within the regulation time frame. Proof of refund and plan of future
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Based on LPA's record review and interview with administrator, the facility failed to ensure R1's responsible party received a refund based on facilitys own admission agreement in compliance with Title 22 which poses a potential health and safty risk to residents in care.
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compliance shall be submitted to CCL by 06/13/2025.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
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