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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005636
Report Date:
03/21/2023
Date Signed:
03/21/2023 03:28:59 PM
Document Has Been Signed on
03/21/2023 03:28 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
CCLD Regional Office
,
770 THE CITY DR., SUITE 7100
ORANGE
,
CA
92868
FACILITY NAME:
MAINPLACE SENIOR LIVING
FACILITY NUMBER:
306005636
ADMINISTRATOR:
RHONWINN HIPOLITO
FACILITY TYPE:
740
ADDRESS:
1800 1832 W. CULVER AVENUE
TELEPHONE:
(714) 978-2534
CITY:
ORANGE
STATE:
CA
ZIP CODE:
92868
CAPACITY:
153
CENSUS:
102
DATE:
03/21/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:46 PM
MET WITH:
Rhonwinn Hipolito - Executive Director
TIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced Case Management visit to Mainplace Senior Living. LPA Velazquez met with Executive Director Rhonwinn Hipolito. During the complaint visit with complaint control number: 22-AS-20230317144713 ED Hipolito had additional questions regarding statute and regulation.
LPA Velazquez provided extensive consultation regarding Title 22 Regulation and the Health and Safety Code. LPA Velazquez impressed the importance of attending the Informational Calls provided to Licensees.
There were no deficiencies issued during this Case Management visit. An exit interview was conducted with Executive Director Rhonwinn Hipolito and a copy of this report was provided at the time of the visit.
SUPERVISOR'S NAME:
Sheila Santos
TELEPHONE:
(713) 334-2062
LICENSING EVALUATOR NAME:
Patricia Velazquez
TELEPHONE:
(949) 236-0556
LICENSING EVALUATOR SIGNATURE:
DATE:
03/21/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/21/2023
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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