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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 490110534
Report Date: 04/20/2026
Date Signed: 04/20/2026 12:00:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/23/2026 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260323153013
FACILITY NAME:LE ELEN MANOR IIFACILITY NUMBER:
490110534
ADMINISTRATOR:GUEVARRA, ANTHONY DFACILITY TYPE:
735
ADDRESS:3467 PHILLIPS AVE.TELEPHONE:
(707) 573-4705
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:20CENSUS: 16DATE:
04/20/2026
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Tony Guevarra (Licensee)TIME COMPLETED:
12:25 PM
ALLEGATION(S):
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-Personal Rights.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Licensee, Tony Guevarra.

There is an allegation of personal rights. The reporting party states that there are concerns that have been raised regarding the care that client (C1) receive at the facility because they make C1 go outside in the cold and rain and the facility has attempted to evict C1 for different things. According to reporting party, C1 was observed with long toenails and dry feet. LPA conducted 10-day complaint investigation visit at the facility on 04/01/2026, obtained pertinent documentation, made observations, and conducted interviews with staff and clients. Based on records review, C1 received on 10/13/25 a client behavior agreement contract signed by C1, C1’s case worker and Licensee as a condition to continue residing at the facility due to incidents of unrespectful behavior towards staff, lack of compliance with house rules, medication and medical appointment refusals indicating failure to comply with the agreement will initiate eviction process. Continue on LIC9099C...

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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 4
Control Number 21-AS-20260323153013
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LE ELEN MANOR II
FACILITY NUMBER: 490110534
VISIT DATE: 04/20/2026
NARRATIVE
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Continue from LIC9099...

C1’s physician report indicates that C1 has a diagnosis of schizophrenia, but they are able to care for personal hygiene and C1’s care plan addresses C1’s goal to maintain appointments with their physician, psychiatrist at least every few months and take all medications as prescribed to decrease mental health needs. LPA obtained police records #SD260323014 did not reveal any supporting evidence of personal rights violation. On 04/01/2026, LPA conducted interviews with C1 revealed conflicting information regarding a possible tall female staff who barely works at the facility a couple times who is the alleged staff who yelled at C1, made them afraid and C1 did not said anything to them, but stated that other staff are ok to them. However, based on interviews conducted by LPA with clients (C2 & C3), staff (S1, S2 & S3) and outside party (I1) did not provide any supportive information about alleged facility staff who could be identified by clients or staff. According to verbal statements from outside party, staff and clients, clients can leave the facility unassisted whenever they want to go outside. Based on LPA’s observations while conducting visits to the facility, there are no staff that could match the description provided by C1. Based on record review, interviews conducted, and observations made, the allegation that the facility has committed a personal rights violation regarding the care provided to C1 is UNSUBSTANTIATED. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
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