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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005865
Report Date: 01/28/2026
Date Signed: 01/28/2026 11:55:11 AM

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
01/22/2026 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20260122102955
FACILITY NAME:RESPIT MANORFACILITY NUMBER:
306005865
ADMINISTRATOR:MENDEZ, MARKFACILITY TYPE:
740
ADDRESS:23255 RESPIT AVETELEPHONE:
(949) 460-0317
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 5DATE:
01/28/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Mark Mendez, Licensee/AdministratorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility is not providing food of good quality
INVESTIGATION FINDINGS:
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On January 28, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced to initiate the complaint investigation into the above allegation. LPA was greeted and granted entry after stating the purpose of the visit to staff. Licensee/Administrator (LI) Mark Mendez was contacted by telephone and arrived shortly to assist with the visit.

Regarding allegation: Facility is not providing food of good quality
It is alleged that the facility is obtaining food items that are close to the expiration dates, from food banks, and serving expired food to residents. During the visit LPA conducted a tour of the facility with staff and Licensee and immediately noticed a sour smell near the two refrigerators in the kitche, being used for residents in care.

CONTINUE TO LIC809-C......
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
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 22-AS-20260122102955
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: RESPIT MANOR
FACILITY NUMBER: 306005865
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2026
Section Cited
CCR
87555(b)(8)
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(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.

This requirement is not met as evidenced by:
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Licensee and staff discarded the expired food items during visit. Licensee stated they will train staff on CCR 87555 and facilty food storage procedures, and will submit proof to CCLD by POC due date of 2/5/2026.
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Based on LPA observation, 15 expired cans of food in the garage and 5 molded vegeteble item were found in the kitchen refridgerator, which poses a potential health and safety risk to persons in care. LI admitted food items were brought from food banks and provided to residents 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.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 22-AS-20260122102955
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: RESPIT MANOR
FACILITY NUMBER: 306005865
VISIT DATE: 01/28/2026
NARRATIVE
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LI confirmed the sour smell. LPA and LI opened refrigerator #1 and observed an open, half used bag of brownish colored broccoli emitting the sour smell. Expired yogurt cups and molded tomatoes were also observed in refrigerator #1. Additionally, 15 expired cans were observed, stored in the garage. LI stated they sometimes bring food items from nearby food banks and provide these items to both residents and staff. LI stated food items were brought from the food banks one week ago.

Based on LPA’s observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

A deficiency is being cited on the attached LIC9099D. An exit interview was conducted with Licensee Mark Mendez, and a copy of this report and appeal rights provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3