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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001093
Report Date: 05/10/2021
Date Signed: 05/10/2021 11:47:54 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/03/2021 and conducted by Evaluator James August
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210503133014
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: DATE:
05/10/2021
UNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Foster Ringor, Administrator TIME COMPLETED:
11:47 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide an appropriate bed for resident
Staff did not seek timely medical care for resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jim August contacted the facility via tele-visit to initiate the 10 day complaint investigation due to COVID-19 and for pre-cautionary measures. LPA spoke with Foster Ringor, Administrator and discussed the purpose of the tele-visit call and explained the allegations.

During the course of the tele-visit, it was discovered that R1 was not a resident at this facility but was rather a resident at Rochelle Manor I (306001096). This complaint was opened under the wrong facility. Therefore, the Department determined the complaint to be unfounded, meaning that the allegations was false, could not have happened and/or is without a reasonable basis. The Department has therefore dismissed the complaint.

An exit interview was conducted with facility representative via tele-visit and a copy of this report was provided to facility representative via email. An electronic email read receipt or response to email indicating as received as confirmation. Administrator agrees to send a signed copy by email.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: James August
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
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 1