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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803259
Report Date: 08/25/2026
Date Signed: 08/27/2026 10:10:54 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
08/24/2026 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260824160558
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: 5DATE:
08/25/2026
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Janet Hermogenes (Licensee)TIME COMPLETED:
03:22 PM
ALLEGATION(S):
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-Staff does not ensure residents are spoken to in an appropriate manner.
-Staff does not ensure beverages are made available to residents at all times.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegations listed above and met with licensee, Janet Hermogenes.

The Department received an allegation of staff does not ensure residents are spoken to in an appropriate manner. According to reporting party, on 8/24/26 a resident (R1) got yelled at by a female staff member because they went into the refrigerator to pore themselves a glass of milk to drink. LPA conducted 10-day visit to the facility on 8/25/26. Based on interviews with licensee, it was confirmed that they got kind of mad, raised their voice at R1 because they were feeling frustrated about things that R1 was saying about them. 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.
Continued on LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
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 3
Control Number 21-AS-20260824160558
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: 08/25/2026
NARRATIVE
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Continued from LIC9099...
Another allegation received about staff does not ensure beverages are made available to residents at all times. Per Reporting party, the administrator does not allow residents to have beverages to drink except during mealtime, staff only allow residents to have water to drink if they are thirsty at any other time of day. Based on interviews conducted with licensee, it was revealed that R1 "got caught" taking things from the fridge, where licensee told them that they need to ask for it, R1 stated that they were getting some milk from the fridge, so licensee told R1 that all they need to do is ask for it. According to licensee, R1 has been residing at the facility for more than 10 years, so they asked R1 to mention a time when licensee didn't allow them to get anything from the fridge, for licensee to get it for them, R1 claimed that they just wanted to get milk. The licensee stated that the facility could easily lock the fridge if they wanted to do it, because there is a lock installed there already, but they are allowing residents to bring things that they like from outside including soy milk or kale which is kept at a kitchen cabinet, where they access to it. Licensee described the incident as a misunderstanding with R1 because it is ok if R1 could have just asked for things in the fridge. Based on LPA’s/Licensee observation, the fridge has a lock in the back, but there is a basket with oranges and apples in the facility pantry; Also, there is a five gallon water dispenser available for residents in care, the fridge was observed unlocked during LPA’s visit. LPA requested the licensee to remove it and licensee removed it immediately. LPA discussed with licensee that a waiver request needs to be submitted to the Department for review and approval if they wish to have a locked fridge, outlining why the refrigerator needs to be locked and how adequate and readily available snacks and beverages will be provided to residents in care. Licensee acknowledged waiver request and its supporting documents would need to be submitted to the Department, but licensee stated that they don’t want to proceed with it. Interviews conducted by LPA with residents in care (R2 & R3) confirmed that they are allowed to put food in the fridge, but they have to ask the licensee to put things in the fridge and they are only allowed to take things from the fridge that they bought not the other food inside the fridge. They are only allowed to take fruits located in the pantry or water from the dispensers. 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.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20260824160558
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: 08/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2026
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 agrees to submit a written plan describing how the facility will ensure residents’ personal rights are not violated at any time to CCL by POC due date.
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Based on interviews with licensee, the facility Licensee raises their voice at R1 when they get frustrated at R1, which poses an immediate risk to the health and safety of clients in care.
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Type B
09/08/2026
Section Cited
CCR
87555(b)(3)
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87555 General Food Service Requirements (b) The following food service requirements shall apply: (3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. This requirement is not met as evidenced by:
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Licensee agrees to submit a written plan how the facility will ensure that there is adequate snacks and beverages available for clients in care per Title 22 Regulation by POC due date.
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Based on LPA's observation and interview's with licensee, the licensee did not comply with the section cited above by limiting access to the main refrigerator where residents' beverages are located, which poses/posed a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3