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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005865
Report Date: 05/26/2026
Date Signed: 05/26/2026 12:24:12 PM

Unsubstantiated


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: 6DATE:
05/26/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Mark Mendez - Licensee/AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility does not have sufficient staffing.
Residents needs are not being met.
INVESTIGATION FINDINGS:
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On May 26, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced to for a subsequent complaint investigation into the above allegations. 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.

During the visit LPA conducted a tour of the facility with staff and reviewed copies of facility documents including: Resident Roster, Staff Roster, Employee Contact Information, Staff Schedule, Resident Emergency Contact Forms, Physician’s Reports, Admission Agreements, and Service Plans.

The investigation revealed the following:

CONTINUE TO LIC9099-C.......
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
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
VISIT DATE: 05/26/2026
NARRATIVE
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Regarding the allegation, Facility does not have sufficient staffing, it was reported that staff quit due to not being paid in a timely manner, resulting in the facility not having staff present to care for residents. During the visits, LPA observed six residents present and two staff on duty. Interviews were conducted with residents and staff. Four out of four residents denied the allegation, stating staff have always been present to care for them and they do not believe the facility has ever been short staffed. LPA was unable to take statements for the remaining two residents due to their medical condition. Two out of two staff denied the allegation. One staff stated they only heard rumors of former staff not being paid but did not have any firsthand information. Another staff stated they recall some staff calling off around November and December 2025, and added there was always sufficient staff present as the other staff worked together to ensure two staff were always working at the facility during the day and one staff there at night, to provide care for residents. Both staff stated they have had no interruption in pay and are paid timely. During an interview, the Licensee admitted paying staff late, resulting in at least two staff quitting, however, they stated there were no gaps in staffing as other staff stepped up to cover the abandoned shifts. A record review of the staff schedule for November 2025 through February 2026, indicates two staff were scheduled everyday from 7am-7pm and one staff scheduled overnight from 7pm-7am. Due to conflicting information obtained, the allegation: Facility does not have sufficient staffing is deemed unsubstantiated.

Regarding the allegation, Residents’ needs are not being met, it is alleged that there were insufficient staff present at the facility, resulting in residents having to wait a long time to receive care. Four out of four residents denied the allegation, stating staff have always been present to care for them and they respond right away. LPA was unable to take statements for the remaining two residents due to their medical condition. All residents successfully interviewed stated they have no issues or concerns with the care being provided now nor in the past. Two out of two staff denied the allegation, stating residents needs are being met as all staff work hard all the time to ensure good care is being provided. There is always someone at the facility available to assist residents with whatever they need. Based on the review of the staff schedule, between November 2025 through February 2026, there were always two staff present for the morning/afternoon shift and one staff present for the evening/overnight shift. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated.


CONTINUE TO LIC9099-C.......
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 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: 05/26/2026
NARRATIVE
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Based on observations made, interviews which were conducted, and records reviewed, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided to Licensee/Administrator (LI) Mark Mendez at the end of the visit.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3