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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001093
Report Date: 03/12/2025
Date Signed: 03/12/2025 04:49:08 PM

Document Has Been Signed on 03/12/2025 04:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ROCHELLE MANORFACILITY NUMBER:
306001093
ADMINISTRATOR/
DIRECTOR:
ALFREDO RINGORFACILITY TYPE:
740
ADDRESS:12841 ADELLE STTELEPHONE:
(714) 537-3188
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 20CENSUS: 10DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Foster RingorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by DSP staff and explained the reason for the visit. The Administrator, Foster Ringor arrived shortly after to assist during the visit. Facility is licensed for twenty non-ambulatory residents, with a hospice waiver for two. Currently there are ten residents residing during today's visit.

LPA Tea reviewed five resident files and staff files. Resident files contained all required documentation. Staff files had some discrepancies with training. Administrator certificate expires on May 25, 2026.

LPA Tea along with Administrator Ringor toured the facility at 10:19 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story home. The first floor is where the residents reside, the second floor is for staff only. The first floor has ten resident rooms and 4 full bathrooms and a half bathroom for staff. There is a kitchen, living room, dining area, laundry area and attached garage. The second floor has four bedrooms and a bathroom for private use for the staff. At the time of the visit the facility is undergoing renovation improvements. The facility has hired contractors to repaint the interior of first floor and kitchen. The floors have been replaced with a nice new vinyl flooring. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each client comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured between 121.1 F degrees and 125.2 F degrees. It was a bit high, Administrator Ringor adjusted the water temperature and immediately created and posted “Hot Water” caution signs around the facility sink faucets. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, dressing, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit.

Continuation of annual report on LIC809C

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.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
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LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to clients underneath the kitchen sink, cabinets in the laundry room and garage. Fire extinguishers are fully charged throughout the facility. The facility’s last fire drill was conducted on March 10, 2025. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade. LPA observed emergency supplies and food in the garage. At the time of the visit the emergency water was being replenished for the week due the water was expired and needed to be replaced. Administrator checks the emergency supply weekly to make sure there are no expired items. At the time of the visit LPA Tea observed residents eating lunch together, and one resident knitting after lunch and a few of them putting puzzles together. The staff provides activities to residents based on their preferences, there are puzzles, games for them to do. They play bingo. From time to time the facility takes residents on outings.

At 10:33 AM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the dining area. Medications are being administered per physician order. P&I Funds were checked and meet department standards. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator Foster Ringor and a copy of this report LIC809, 809-C, LIC858, LIC859, and LIC9102TV was read and 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
LIC809 (FAS) - (06/04)
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