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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803259
Report Date: 06/11/2025
Date Signed: 06/11/2025 10:24:58 AM

Substantiated


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
05/09/2025 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250509113031
FACILITY NAME:LE ELEN MANOR, INC.IVFACILITY NUMBER:
496803259
ADMINISTRATOR:HERMOGENES, JANETFACILITY TYPE:
740
ADDRESS:505 UMLAND DRIVETELEPHONE:
(707) 527-9656
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: DATE:
06/11/2025
ANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Janet Hermogenes (Licensee)TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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-Staff yell at residents.
-Staff do not allow residents to have visitors.
INVESTIGATION FINDINGS:
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An informal meeting was conducted today in the Santa Rosa Regional Office to deliver findings. Present in the meeting were Licensing Program Manager Bethany Moellers, Licensing Program Analyst Marisol Cuadra and Licensee of the facility, Janet Hermogenes.

The Department received an allegation of staff yell at residents. Per Reporting Party, staff (S1 & S2) yell at clients when they ask for hygiene supplies. Reporting Party witnessed on 4/14/25, while speaking to a client on the phone, they overheard Licensee yelled at client (C1). On 5/13/25, LPA conducted 10-day visit to the facility, conducted confidential interviews with staff and clients in care. Based on confidential interviews conducted with clients in care (C1, C2 & C3) it was revealed that Licensee raises their voice at clients resulting in clients avoid making eye contact or stare at Licensee to reduce the possibility of been yelled at them, they are fearful of retaliation by Licensee and/or risking the stability of their housing.
Continue on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
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 5
Control Number 21-AS-20250509113031
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, INC.IV
FACILITY NUMBER: 496803259
VISIT DATE: 06/11/2025
NARRATIVE
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Continued from LIC9099...

A related complaint about Licensee yelling at the residents was previously substantiated see complaint # 21-AS-20241125153637. Although, LPA was unable to receive confirmation from Licensee if this communication approach keeps happening or not; Licensee suggests that their accent when they speak Tagalog with S2 in front of the clients could be the cause of their fear. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. The Department will review information obtained to determine if any further action is needed.

Regarding allegation of staff do not allow residents to have visitors. The Reporting Party stated that the Licensee would not allow them to go to the facility to meet with C1 there, after client has asked them and they said no. Based on records review, the facility provided LPA with house rules including visitation hours between 8am to 6pm daily. However, Licensee provided LPA with a written addendum to house rules issued and signed on 5/5/25 by C1 only, where the notice instructs them that visitor, specifically individual (I1) as follow: “I1 needs to call Licensee or S2 ahead of time. Have I1 not to hang out at/or front door in front of the house. Licensee or S2 will ask them to leave”. Based on interviews with Licensee, I1 used to call the facility phone number when they are at the front door during non-visiting hours (10:30pm-11pm) and hangs up, but C1 at times refuses to see I1, but when I1 shows at the door, they will leave together, so Licensee is taking this approach to protect C1 from I1, because according to Licensee C1 doesn’t know how to set boundaries with I1. Although, C1 expressed to LPA that they have not asked the Licensee for it. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. The Department will review information obtained to determine if any further action is needed.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20250509113031
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, INC.IV
FACILITY NUMBER: 496803259
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/12/2025
Section Cited
HSC
1569.269(a)(1)
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Type A - §1569.269 Enumerated rights; severability (a) Residents of RCFE shall have all of the following rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met as evidence by:
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Licensee to ensure all residents are always treated with dignity and respect. Licensee agrees to sign LIC9098 attesting understanding of Health and Safety Code 1569.269, Enumerated Rights by POC due date of 6/12/2025.
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Based on interviews with residents and staff, the facility Licensee yells at residents resulting in residents are avoiding making eye contact to prevent Licensee from raising their voice at them, which poses an immediate risk to the health and safety of clients in care.
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Type B
06/20/2025
Section Cited
CCR
87468.1(a)(11)
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Type B -87468.1 Personal Rights of Residents in All Facilities (a) Residents in all RCFE shall have all of the following personal rights: 11) To have their visitors, including…advocacy representatives, permitted to visit privately during reasonable hours & without prior notice, provided that the rights of other residents are not infringed upon…This requirement has not been met as evidence by:
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Licensee will ensure that residents rights are maintained. Licensee will submit a self-certification (LIC9098) that all staff had been notified about regulation by POC due date of 6/20/2025.
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Based on records review and interviews conducted with the Licensee. The Licensee did not ensure the compliance of above regulation due to issuing an addendum to visitation policy to C1 only to discourage C1’s visitors from visiting regularly, which it could be a potential personal rights risk to the residents in care.
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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: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/09/2025 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250509113031

FACILITY NAME:LE ELEN MANOR, INC.IVFACILITY NUMBER:
496803259
ADMINISTRATOR:HERMOGENES, JANETFACILITY TYPE:
740
ADDRESS:505 UMLAND DRIVETELEPHONE:
(707) 527-9656
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:6CENSUS: DATE:
06/11/2025
ANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Janet Hermogenes (Licensee)TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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-Staff do not ensure the facility is clean and sanitary.
-Staff do not ensure resident has sufficient hygiene products.
INVESTIGATION FINDINGS:
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An informal meeting was conducted today in the Santa Rosa Regional Office to deliver findings. Present in the meeting were Licensing Program Manager Bethany Moellers, Licensing Program Analyst Marisol Cuadra and Licensee of the facility, Janet Hermogenes.

The Department received an allegation of staff do not ensure the facility is clean and sanitary. Per Reporting Party, the facility is not clean (specific details were not provided). On 4/29/25, LPA conducted the facility annual and on 5/13/25 LPA conducted 10-day visit to the facility. LPA/Licensee toured the facility inside and outside and made observations. During the tour of the physical plant the bathrooms appeared clean, free of odors and sanitary. There were some areas that could be improved with enhanced cleaning including some debris observed in the backyard that Licensee stated they were in the process of clean them out.

Continue on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20250509113031
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, INC.IV
FACILITY NUMBER: 496803259
VISIT DATE: 06/11/2025
NARRATIVE
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Continued from LIC9099A...

Based on LPA’s interviews with clients in care and observations, LPA has determined and confirmed that although the facility appeared to be clean and in a sanitary condition on recent LPA inspections conducted on 04/29/25 and 05/13/25, LPA is unable to determine if an area of the facility was unclean or unsanitary condition at a prior date. A finding that the complaint allegation staff do not ensure the facility is clean and sanitary condition is unsubstantiated meaning that 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.

Another allegation was received regarding staff do not ensure resident has sufficient hygiene products. According to the reporting party, client (C1) has asked the Licensee for more shampoo, and they yelled at them about that. On 5/13/25, LPA conducted 10-day visit to the facility, toured the facility inside and outside with Licensee and it was observed in the facility storage two single boxes of toothpaste, 15 soap bars, one box of Q-tips, three bottles of shampoo, three toothbrushes, two bottles of antibacterial soap (8 ounces) and cleansers available, which are in compliance with agreed basic hygiene items indicated in client’s admissions agreements. Based on confidential interviews with clients (C1, C2 & C3) it was clarified that Licensee do provides hygiene items to them, but not in a pleasant manner when they request such basic items. A finding that the complaint allegation occurs of staff do not ensure resident has sufficient hygiene products is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5