<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001093
Report Date: 04/06/2022
Date Signed: 04/07/2022 08:42:58 AM

Document Has Been Signed on 04/07/2022 08:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
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: 12DATE:
04/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:34 PM
MET WITH:Foster RingorTIME COMPLETED:
05:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Claudia Gutierrez and Andrea Mendivil and Licensing Program Managers (LPMs) Alisa Ortiz and Armando Lucero for the purpose of conducting an Required/Annual Inspection. LPAs and LPMs were greeted by Maria “Tess” Castillo and Administrator (AD) Foster Ringor who arrived shortly after at 3:44pm. LPA Gutierrez discussed the purpose of the inspection. During the inspection LPAs, LPMs and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following:

This is a two-story house with staff quarters upstairs. LPAs and LPMs observed and toured the staff quarters where two of the four bedrooms were locked; a Technical Advisory was given on this date. Ten resident bedrooms and 5 bathrooms were found to be downstairs. During the inspection, LPAs, LPMs, and AD observed there were 3 staff present. Residents were observed socializing, playing games, and watching a movie in the living room and dining area. LPAs and LPMs inspected common areas, resident rooms, kitchen, and garage and observed a 2-day supply of perishables and a 7-day supply of non-perishable food is available. LPA observed hallways and walkways were free of obstruction.

LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, infection control training, PPE, staffing and staffing shortages.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report, due to technical issues LPA Gutierrez will email AD report first thing in the morning and will also be mailing by certified mail.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2