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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 05/25/2023
Date Signed: 05/25/2023 11:51:15 AM

Unsubstantiated


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
05/18/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230518155233
FACILITY NAME:MAINPLACE SENIOR LIVINGFACILITY NUMBER:
306005636
ADMINISTRATOR:RHONWINN HIPOLITOFACILITY TYPE:
740
ADDRESS:1800 1832 W. CULVER AVENUETELEPHONE:
(714) 978-2534
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:153CENSUS: 98DATE:
05/25/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rhon HipolitoTIME COMPLETED:
12:01 PM
ALLEGATION(S):
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9
Staff did not ensure residents room was clean.
Resident's appearance is unkempt due to staff neglect.
Staff did not ensure resident's bathroom was clean.
Staff did not ensure resident had toilet paper.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Executive Director Rhon Hipolito. LPA explained the reason for the visit. The investigation into the allegation, staff did not ensure resident's room was clean, revealed the following. It was alleged the Resident 1's (R1) room was not kept clean. Staff reported that all rooms are cleaned once a week and as needed if something is noticed by staff or reported by residents or their visitors. Staff interviewed reported that resident rooms are cleaned regularly but sometimes residents have accidents and they are cleaned as quickly as possible. LPA toured the facility and did not observe any rooms that were not clean. LPA toured R1's former room and observed it was clean. No evidence was provided that supports the allegation. Based on the evidence gathered the allegation, staff did not ensure residents room was clean is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Regarding the allegation, resident's appearance is unkempt due to staff neglect, the investigation revealed the following.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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-20230518155233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 05/25/2023
NARRATIVE
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It was alleged facility staff neglected the resident and their appearance was unkempt. Staff interviewed reported all the residents are properly cared for and no one is neglected. Staff reported that R1's appearance was not unkempt. R1 no longer resides at the facility. LPA observed all of the residents in memory care and none of the residents appeared unkempt and all of the residents were wearing clean clothes. None of the evidence gathered corroborates the allegation, therefore the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Regarding the allegation, staff did not ensure resident's bathroom was clean, the investigation revealed the following. LPA inspected R1's former room, including the bathroom. LPA observed the bathroom was operational and clean. No deficiencies observed. Staff reported that the bathroom is cleaned at least once a week and as needed. Staff reported that if they notice the bathroom needs to be cleaned or a resident requests, they have the bathroom cleaned. Based on the evidence gathered the allegation, staff did not ensure resident's bathroom was clean, is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Regarding the allegation, staff did not ensure resident had toilet paper, the investigation revealed the following. Staff reported that all bathrooms are checked for toilet paper when they are cleaned and toilet paper is provided when residents request it, Staff reported that sometime in April R1's family reported there was no toilet paper and staff put toilet paper in the bathroom. This report could not be corroborated. Staff reported that no other reports have been made that any bathrooms were out of toilet paper. LPA observed that R1's former room had toilet paper in the bathroom. Based on the evidence gathered the allegation, staff did not ensure resident had toilet paper, is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
05/18/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230518155233

FACILITY NAME:MAINPLACE SENIOR LIVINGFACILITY NUMBER:
306005636
ADMINISTRATOR:RHONWINN HIPOLITOFACILITY TYPE:
740
ADDRESS:1800 1832 W. CULVER AVENUETELEPHONE:
(714) 978-2534
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:153CENSUS: 98DATE:
05/25/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rhon HipolitoTIME COMPLETED:
12:01 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident's mattress was clean.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Executive Director Rhon Hipolito. LPA explained the reason for the visit. The investigation into the allegation, staff did not ensure resident's mattress was clean, revealed the following. It was alleged that Resident 1's (R1) mattress had blood stains. Staff reported R1's former room is unoccupied and the mattress had not been replaced. LPA inspected R1's former room and mattress. LPA observed the linens were clean. The linens were removed and LPA observed the mattress was clean and did not have any stains. Based on the evidence gathered the allegation, staff did not ensure resident's mattress was clean, is deemed unfounded meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3