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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 490108263
Report Date: 11/19/2025
Date Signed: 11/19/2025 02:51:51 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
11/13/2025 and conducted by Evaluator Dina Alviso
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20251113013847
FACILITY NAME:LE ELEN MANOR, INCFACILITY NUMBER:
490108263
ADMINISTRATOR:GUEVARRA, ANTHONYFACILITY TYPE:
735
ADDRESS:5522 OLD REDWOOD HWYTELEPHONE:
(707) 569-9478
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:20CENSUS: DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Agusto (Gus) Guevarra-House Manager/Lead CaregiverTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alviso conducted a complaint investigation visit, on 11/19/25 at approximately 10:00am, and met with House Manager/Lead Staff Augusto (Gus) Guevarra.

LPA reviewed resident records, and obtained copies from Gus Guevarra, Reporting party alleges that "staff did not provide adequate supervision to residents in care." There were no specific dates and/or times provided with the alleged violation. LPA reviewed resident records, conducted interviews with staff, and other related parties. LPA reviewed resident roster.

The investigation revealed that none of the residents' in care are a one to one staff, meaning none of the residents' have need to have a caregiver supervising only them; The staff on duty supervise all residents in care. Per LPA's review of records, residents' are documented in medical assessments by the Physician to be able to access the community on their own. Per LPA's interviews, with staff, and other parties, residents are able to leave the facility on own, are provided meals/snacks, provided needed care, hygiene reminders/assistance, medication assistance, and assistance to access their medical care when needed/scheduled.
Continued on LIC9099C..
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 21-AS-20251113013847
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: LE ELEN MANOR, INC
FACILITY NUMBER: 490108263
VISIT DATE: 11/19/2025
NARRATIVE
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Per interviews with staff, residents' are to respect each other, including a resident's personal space, privacy, each others personal choices, belongings, and not to go uninvited into another resident's room. Residents' are provided "house rules" of the facility upon admission. Per interviews, residents' are reminded about respecting one another and the house rules almost daily, and as often as needed.

Per interviews, staff have not received reports of incidents occurring of concern of a a resident's safety, a resident being aggressive to another resident regarding sexual requests. Per interviews, the incidents were not reported to staff, and staff were unaware of any issues or concerns by any of the residents'. There was no information obtained that supported the violation had occurred.

During the inspection, LPA discussed personal rights of residents in care, and ensuring all resident needs are met by the facility. Administrator Tony Guevarra, and House Manager Gus Guevarra stated their understanding of the above. Staff agreed to review resident personal rights, and house rules with all residents' in care, including reporting to staff any concerns they may have.

Based on LPAs observations, record reviews, interviews with staff, and interviews with other related party(s) there is insufficient information to prove or disprove the allegation of "staff did not provide adequate supervision to residents in care". 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 allegations are Unsubstantiated.

No deficiencies cited.
Exit interview conducted with Lead Staff/House Manager, Agusto Guevarra.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Dina Alviso
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
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