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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005636
Report Date:
07/05/2023
Date Signed:
07/05/2023 12:37:34 PM
Document Has Been Signed on
07/05/2023 12:37 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:
07/05/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:01 PM
MET WITH:
Rhonwinn Hipolito
TIME COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a case management visit. LPA met with Executive Director (ED) Rhonwinn Hipolito and explained the reason for the visit. During the 10-day complaint visit (Complaint # 22-AS-20230630114211 dated 6/30/23) LPA observed the See Something Say Something Poster (PUB 475) was not posted in the main entryway of the facility. LPA observed Ombudsman posters posted by the elevator on the first and second floors. LPA informed the ED the See Something Say Something Poster must be posted in the entrance of the facility. The ED stated he understood and would have the poster moved. LPA issued a Technical Assistance Advisory Note. An exit interview was conducted and a copy of the report and Advisory Note LIC 9102TA was provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
07/05/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/05/2023
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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