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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001093
Report Date: 03/12/2025
Date Signed: 03/12/2025 04:52:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/05/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250305141140
FACILITY NAME:ROCHELLE MANORFACILITY NUMBER:
306001093
ADMINISTRATOR:ALFREDO RINGORFACILITY TYPE:
740
ADDRESS:12841 ADELLE STTELEPHONE:
(714) 537-3188
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY:20CENSUS: 10DATE:
03/12/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Foster RingorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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- Facility has bed bugs
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conduct a complaint investigation. LPA Tea was greeted and granted entry into the facility by a caregiver and explained the reason for the visit. Administrator (AD) Foster Ringor arrived later to assist with the visit.

The department received a complaint on March 5, 2025, and LPA Tea conducted the initial 10-day visit a week later on March 12, 2025. It was alleged that facility has bed bugs. LPA Tea interviewed facility staff and collected pertinent documents such as staff and resident rosters, copies of Resident 1’s (R1) physician’s report, R1’s Body Check Report, furniture purchase receipts and pest control maintenance paperwork. The investigation determined the following:

The department received notice about Resident 1 (R1) residing at Rochelle Manor had bed bugs on their sleigh and wheelchair at the day program they attend. The photos obtained show dead bed bugs on R1’s items and photos of dirt and debris around the wheelchair and sleigh. LPA Tea emailed the facility and

Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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 3
Control Number 22-AS-20250305141140
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROCHELLE MANOR
FACILITY NUMBER: 306001093
VISIT DATE: 03/12/2025
NARRATIVE
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received a follow up email from Administrator Foster Ringor on February 4, 2025 that exterminators were coming to do inspection that day to do a home inspection and treatment to the affected room. AD Ringor followed proper procedure and reported to Orange County Public Health and Orange County Regional Center about the bed bugs.

Per records obtained, Hawx Smart Pest Control paperwork shows initial inspection and agreement made for treating bed bugs in the facility. On February 10, 2025, a report from the pest control company showed the exterminators completed the bed bug service treatment for six bedrooms for bed bug activities. When asked about the cleanliness of the wheelchair and sleigh, Administrator Ringor stated that they were not on top of maintaining resident items since the incident they do daily wheelchair checks in the morning. Per interviews conducted, four out four staff confirmed that there were bed bugs at the facility. All staff interviewed said the facility treated and responded to the bed bugs right away and that there are no more bed bugs at the facility.

The Body Check Report obtained show R1 having no bites or changes in skin conditions. Facility has purchased brand new replacement mattresses and bedframes for the facility as well.

Therefore, based on the preponderance of evidence through records reviewed and interviews the allegation facility has bed bugs is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred.

The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.

An exit interview was conducted with Administrator Foster Ringor and a copy of this report and appeal rights was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250305141140
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ROCHELLE MANOR
FACILITY NUMBER: 306001093
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2025
Section Cited
CCR
87303(a)
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Maintenance and Operation ... The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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Before complaint investigation was conducted the facility had eradicated the bed bug infestation. They had pest control do initial inspection on 02/04/25 and treatment on 02/10/25. Moved resident to another room, wash and treated clothing and bedding and replaced mattresses.
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Facility had bed bug infestation. This poses an immediate health and safety risk to residents in care.
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CCR
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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: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3