Respit Manor Mission Viejo

Allegation investigated: Facility did not issue responsible party a refund.

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA was greeted and granted entry by Caregiver John Panganiban and explained the reason for the visit. Administrator (Admin) Mark Mendez was informed of the visit by telephone and arrived at 2pm. During the course of the investigation, LPA interivewed two staff and obtained the following pertinent documentation: Resident Roster, Personnel Report Summary, Face Sheet, Physician's Report, Admission Agreement, hospice records, bank statement, and text message receipts. The investigation revealed the following: Regarding the allegation, facility did not issue the responsible party a refund, it is alleged the representative of Resident #1 (R1) was not issued a refund after Resident #1 (R1) passed away. R1 began hospice care on February 19, 2026 and passed away on May 2, 2026 per face sheet. LPA verified faciity did not comply with the reporting requirements as the Department did not receive a death report for R1. Substantiated Per the admission agreement, R1's rate is $5,500.00. Admin Mendez confirmed R1's representative was issued a $500.00 refund which R1 confirmed via text on July 8, 2026 at 12:32pm. R1 confirmed still having an outstanding balance of $5000.00. Admin indicated R1's representative will be reimbursed the full amount although resident resided at the facility for two days in May 2026. Therefore, based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility did not issue responsible party a refund is deemed SUBSTANTIATED. A deficiency is being cited on the attached LIC9099D. An exit interview was conducted with Administrator Mark Mendez, and a copy of this report including the LIC9099C, LIC811, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Aug 13, 2026 · control 22-AS-20260812162938

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Aug 27, 2026

87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement was not met as evidenced by: Based on interview and record review, facility issued a partial $500.00 refund after R1 passed on 5/2/26 and still has an outstanding balance owed of $5k which poses a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Administrator stated proof of $5000.00 refund certified mailed to R1's representative and proof the issued amount has been withdrawn by POC due date to LPA via email by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of issuing deficiencies in connection to complaint investigation control number 22-AS-20260812162938. LPA explained the reason for the visit to Administrator Mark Mendez. During the investigation mentioned above, LPA observed two staff on duty, Staff #1 (S1) and Staff #2 (S2). The clearance transfer for S1 was incomplete. S2 was previously fingerprint cleared according to annual inspection date March 16, 2026. However, LPA verified S2 was separated from the facility on May 7, 2026 which Admin denied completing the separation. LPA verified S1 and S2 are not associated per Guardian and the Department's Licensing Information System Personnel Report Summary dated August 13, 2026. Additionally, facility did not comply with the reporting requirements as death report for Resident #1 (R1) was not reported to the Department. The annual licensing fee in the amount of $742.00 was paid during the visit. Deficiencies are being cited and an immediate civil penalty is being issued. An exit interview was conducted with Administrator Mark Mendez, and a copy of this report including the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Aug 13, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2-3) · Plan of correction due date: Aug 14, 2026

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance...(3) Request a transfer of a criminal record clearance... This requrement was not met as evidenced by: Based on observation and record review, a transfer of criminal record clearance for S1 and fingerpring clearance for S2 were not met. S2 was previously fingerprint cleared and was separated on 5/7/26 which poses an immediate Health, Safety, and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Admin stated proof of fingerprint clearance and/or transfer request will be forwarded to LPA via email by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(A) · Plan of correction due date: Aug 17, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... (A) Death of any resident from any cause regardless of where the death occurred... This requirement was not met as evidenced by: Based on record review and the Department's system, there was no record of a death report for R1 which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 13, 2026

Plan of correction: Admin will forward a death report for R1 to LPA via email by POC due date.

Allegation investigated: Facility is not providing food of good quality.

Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegation. LPA met with facility representative and explained the purpose of the visit. During the investigation, the following was completed: LPA inspected the facility, interviewed staff and residents, obtained and reviewed food receipts and staff schedules. The investigation revealed the following: It was alleged that facility is not providing food of good quality. LPA toured the facility kitchen on January 29, 2026 and March 27, 2026. On March 27, LPA observed the fridge’s temperature was within range. During the food inspection visit, LPA verified the facility met the minimum two-day perishable supply and seven-day nonperishable supply. LPA observed that facility food supplies and groceries are purchased using facility credit/debit cards shared by the facility including food receipts. Continued on LIC9099-C. Substantiated Witness reported that some of the food is collected from a food bank. It was reported that food deliveries are on Thursdays or Fridays from Sam’s Club. During the food inspection LPA observed blueberry muffins in the fridge with an expiration date of March 22, 2026 is expired. One out of five witnesses interviewed confirmed that the fruits are overripe on occasions and not edible for consumption. Based on evidence gathered through interviews and document review, the preponderance of evidence has been met, therefore, the above allegation are found to be Substantiated. Violations are being cited per Title 22 of California Code of Regulations. See LIC 9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with authorized representative and a copy of this LIC9099 and LIC9099-D, along with a copy of the Appeal Rights were left at the facility. It was alleged that residents’ needs are not being met. Based on observation, all residents appeared clean and well-groomed during the visits on January 29, 2026, and March 27, 2026. Five out of five interviews conducted with staff confirmed that residents’ needs were being met. Staff reported that they assist residents as needed. Two out of two residents interviewed confirmed that their needs were being met. Interviews with witnesses and one resident explained that staff comes quickly when the call button is pressed. Witness confirmed that residents have met all their needs. Based on evidence gathered during this investigation, although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Authorized representative, and a copy of the report was reviewed and provided during the visit.the state’s words, verbatim · CDSS document, Apr 8, 2026 · control 22-AS-20260122083457

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(8) · Plan of correction due date: Apr 15, 2026

General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality. [...]. This requirement was not met as evidenced by: Based on observations and interviews, the licensee did not ensure that all expired foods stored at the facility were disposed of, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 8, 2026

Plan of correction: Staff disposed of food item immediately during the visit. Deficiency cleared during the visit. Licensee agrees to review all perishable and non-perishable food items on a weekly basis and dispose of any items that have exceeded the expiration dates. Licensee will provide training to all staff regarding the Title 22 regulation 87555 General Food Service Requirements and will provide proof of the training to LPA by POC due date.

Type of visit: Required - 1 Year

On March 16, 2026, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the facility administrator (AD) Mark Mendez about the visit. For this visit, there are two staff members on duty, both of which are background cleared and associated. AD later arrived to assist with the inspection. The PUB475 ‘See Something, Say Something’ poster was observed to be located near the front entrance. LPA observed that Mark Mendez has a valid Administrator certificate which expires on September 26, 2026. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, one of which may be bedridden, and a hospice waiver for six. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of two non-ambulatory residents, and one ambulatory resident in care, no one is on hospice, and none are bedridden. The facility is a single story home. There are a total of four bedrooms, two of which are private resident bedrooms and two shared bedrooms. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of two bathrooms. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathroom were measured to be 121.8 degrees Fahrenheit. Continued on LIC809-C. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Fire extinguisher was purchased on July 1, 2024. LPA observed the emergency disaster and evacuation plan, which is posted in the dining room. Facilitator stated the facility conducted their last emergency disaster drill last year, but it was not documented. Facility had back-up emergency food and water supply, located in the garage. LPA observed that the First Aid kit had all the required components. Medications were observed to be locked in a medication cabinet in the dining room, inaccessible to residents in care. Chemicals were observed to be locked in the garage. LPA observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. The garage is used for storage and laundry. For the exterior portion, LPA observed patio furniture under shading, and the grounds were free of any hazards or obstructions. There are two self-latching gates in the backyard that can be opened in case of an emergency. No bodies of water were observed. During this visit, three resident files and two staff files were reviewed. All staff are background cleared and associated with the facility. LPA reviewed residents’ medication and medication records and two resident and two staff interviews were conducted. Based on today's observations, there are deficiencies being cited per Title 22 of the California Code of Regulations. Technical violations were issued. An exit interview was conducted with Mark Mendez. This report was reviewed with the administrator and a copy was provided at the end of the visit. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, Mar 16, 2026

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:45 AM, LPA Tea was greeted and granted entry into the facility by caregiver staff and explained the reason for the visit. Administrator (AD) Mark Mendez arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents, of which one maybe bedridden, with a hospice waiver for six. Currently there are five residents, of which no one is on hospice during today's visit. LPA Tea along with caregiver staff toured the facility at 9:04 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of four resident bedrooms, two bathrooms, living room, dining room, kitchen and an attached garage. 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 resident 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 111.3 F degrees and 111.7 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, and doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply were checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to Annual inspection continued on LIC809-C clients underneath the kitchen sink and the garage. Fire extinguisher in the kitchen is fully charged. The facility’s last disaster drill was conducted in March 27, 2025. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating with shade and there are two exit gates on both sides of the house that are self-latching and operational. The backyard has a shaded patio area for clients to sit. LPA observed emergency supplies, food and water in the garage. Activities are based on resident’s personal preference or health condition. Facility provides activities like board games, exercise like walking outside. At the time of the visit, LPA observed residents watching television, eating lunch and going outside for a walk. At 9:40 AM, LPA Tea reviewed five resident files and two staff files. There were some minor discrepancies with record keeping. Administrator certificate expires on September 26, 2026. LPA then reviewed medication storage and administration. Medications are stored in a locked cart in the kitchen area. Medications are being administered per physician order. However, medication provided by resident’s family or responsible party are not listed as prescribed medication or doctor’s order. LPA interviewed clients 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 the facility and a copy of this report LIC809, 809-C, LIC858, LIC859, LIC9102 was read and provided to the facility.the state’s words, verbatim · CDSS document, Apr 11, 2025

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Rosekie Cristobal. Caregiver Michael Abada arrived shortly after. According to the facility’s license, the facility has a maximum capacity of six residents, of whom all may be non-ambulatory and one may be bedridden. LPA toured the interior and exterior of the facility and inspected each room. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were stored in locked areas. LPA observed medication for one resident stored in a zip lock bag with no prescription label. No pool or body of water was present. Water temperature was measured at 109 degrees F. Per Michael, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit was complete. Resident records reviewed did not have needs and services plan in 4 of 4 residents. No medical assessments were present for two of four residents. One resident with a major neurocognitive disorder's most recent medical assessment was from 2021. Hospice resident full bed rail orders were present. Staff records reviewed contained required documentation. Multiple deficiencies were issued on today's date. An exit interview was conducted with Michael Abada, to whom a copy of this report, LIC809 D (x3) and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jul 12, 2024

Allegation investigated: Facility staff did not refund the residence fees paid after a resident passed away.

LIcensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of initiating the 10-day complaint investigation into the above allegation. LPA was greeted and granted entry by Caregiver Michael Dorin Abada and stated the purpose of the visit. Administrator (Admin) Mark Mendez was also advised of the visit upon arrival approximately 9:30am. During the course of the investigation, LPA interviewed Administrator Mendez and obtained pertinent documentation which includes the Resident Roster, Face Sheet, Physician's Report, Hospice Records, Admission Agreement, and Billing Invoices from January to April 2024 pertaining to Resident #1 (R1) in addition to the screenshots of the text messages exchanged between the Admin and R1's family member. Additional docuementations that were verbally requested will be sent to LPA's email by close of business June 13, 2024. The investigation revealed the following: It is alleged that the facility staff did not refund the residence fees paid after a resident passed away. Substantiated Per the hospice records dated June 12, 2024, R1 passed away on March 14, 2024. R1 was not refunded upon death for the remainder of March 2024 as agreed per the Admission Agreement dated and signed on July 3, 2023. R1 was also additionally billed for April 2024 in the amount of $4,000.00 after their passing. Admin confirmed and agreed to reimburse a portion of March 2024 and the full amount for the April 2024. The demand amount is of $5,500.00. Admin stated that the $1,000 was reimbursed and facility now currently owes $4,500.00. Therefore, based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility staff did not refund the residence fees paid after a resident passed away is deemed SUBSTANTIATED as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. A deficiency is being cited on the attached LIC9099D. An exit interview was conducted with Administrator Mark Mendez, and a copy of this report including the LIC9099C, LIC811, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jun 12, 2024 · control 22-AS-20240606140114

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(A) · Plan of correction due date: Jun 30, 2024

87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions. (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement was not met as evidenced by: Based on interviews and record review, facility did not issue a refund for R1 for part of March 2024 and the entire month for April 2024 which poses a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 12, 2024

Plan of correction: Administrator stated that they will issue the refund of $4500 and ensure that the $1000 that was issued is withdrawn and will provide proof of reimbursement in the amount of $5500 to LPA via email by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jessica Cho continued the visit after delivering the findings in connection to Complaint Control Number: 22-AS-20240606140114. LPA stated the purpose of the visit to Administrator Mark Mendez. LPA observed Staff #1 (S1) was not associated per the Licensing Information System (LIS) and the Guardian Employee Roster dated June 12, 2024 as required per the Criminal Record Clearance of the Title 22 Regulations. S1 stated that they were employed approximately June or July 2022. A deficiency is being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC809-D. An immediate civil penalty is being assessed. See the attached LIC421BG. An exit interview was conducted with Administrator Mark Mendez, and a copy of this report including the LIC809D, LIC421BG, LIC811, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Jun 12, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jun 13, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance... This requirement was not met as evidenced by: Based on observation, interviews, and record review, S1 was not associated at the time of the visit which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 12, 2024

Plan of correction: Administrator stated they will request in writing to associate S1 and to provide proof of access to Guardian, and to submit an Acknowledgement of Understanding of the said deficiency to LPA via email by POC due date.