306005636-12-14-2022-22-AS-AJLO-CMATKM-20221220134808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 12/14/2022
Date Signed: 12/14/2022 12:05:43 PM

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
08/02/2022 and conducted by Evaluator Claudia Gutierrez

COMPLAINT CONTROL NUMBER: 22-AS-20220802095010

FACILITY NAME:	MAINPLACE SENIOR LIVING		FACILITY NUMBER:	306005636
ADMINISTRATOR:	PHAT T. NGUYEN		FACILITY TYPE:	740
ADDRESS:	1800 1832 W. CULVER AVENUE		TELEPHONE:	(714) 978-2534
CITY:	ORANGE	STATE: CA	ZIP CODE:	92868
CAPACITY:	153	CENSUS: 88	DATE:	12/14/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Rhon Hipolito		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Resident's medication was not administered as prescribed.

Staff are not properly trained.

Staff do not answer facility phone.

Facility is in disrepair.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above for the purpose of delivering findings. LPA met with Administrator In Training (AIT) Rhon Hipolito and discussed the purpose of the visit.

Complaint alleges resident's medication was not administered as prescribed, staff are not properly trained, staff do not answer facility phone, and facility is in disrepair.

LPA interviewed two Medication Technicians and Wellness Director (WD) Kim Mims regarding allegation resident’s medication not administered as prescribed. Three out of three staff stated that the electronic Medication Administration Record (MAR) allows medication to be administered or checked as administered an hour before or an hour after the prescribed time. LPA reviewed Resident 1’s (R1’s) MARs for the month of July and August. On the MARs, there are administration times of 8 a.m., 9 a.m., 7 p.m., and 8 p.m. with staff initials and a check mark to indicate that the medication was administered. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220802095010

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: 12/14/2022

NARRATIVE

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Due to the fact that the MARs are not time stamped LPA is unable to determine the exact time the medication was administered. LPA interviewed six residents regarding allegation resident’s medication not administered as prescribed. Three out of six residents reported medication is administered as prescribed and is given regularly at the same time. Three out of six residents were unable to confirm or deny if they take medication or if it is administered as prescribed.

During interviews Reporting Party (RP) stated staff are not properly trained because “some of the Med Techs don’t have the tactfulness to deal with residents that are a little incoherent.” LPA interviewed former Executive Director (ED) Phat Nguyen and two Medication Technicians regarding allegation staff are not properly trained and all stated staff is trained and live in-service training and regulatory training is given through an online training academy. LPA reviewed online academy training records from January 2022 to June 2022 and determined care staff including Medication Technicians took training courses on the following, Providing High Quality Care, Alzheimer’s Disease and Related Disorders: Communication, Dementia Care: Challenging Behaviors, Caring for Those with Cognitive Impairment, Dementia Care: Activities for People with Memory Problems, Alzheimer’s Disease and Related Disorders: Activities of Daily Living. Six residents were also interviewed regarding allegation staff are not properly trained. Four out of six residents stated staff is properly trained and two out four were unable to confirm or deny allegation.

RP stated that the facility does not answer the phone at night. Interviews were conducted with former ED Phat Nguyen and two care staff regarding allegation staff do not answer facility phone. Three out of three staff reported after the receptionist leaves, between 4:30 p.m. and 5 p.m., calls are forwarded to cell phones provided to care staff by the facility and it is the responsibility of all care staff on shift to answer the phone. LPA placed a call to facility in the evening on two separate occasions, the first call on 11/27/22 at 8:25 p.m. and the second call on 11/30/22 at 8:57 p.m. Two out of two calls were answered by care staff.

RP stated facility is in disrepair regarding R1’s plumbing, lack of air conditioning or lack of proper ventilation. On 08/04/22 LPA initiated complaint investigation, visited facility, and tested plumbing in R1’s personal bathroom, located inside R1’s bedroom. LPA found toilet and sink faucet to be operational. During interviews conducted, R1 was unable to confirm or deny if facility is in disrepair or if there is a lack of proper ventilation. During visit LPA observed R1 in their bedroom laying in their bed under their bedding. During staff interviews, four out of four staff stated they were unaware if the facility is or was in disrepair but denied facility air conditioner is inoperable. (Cont. LIC 9099-C)

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20220802095010

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: 12/14/2022

NARRATIVE

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Five additional residents were interviewed regarding allegation facility is in disrepair, five out of five residents reported everything in their bedroom is operable and stated they were unaware if anything else at the facility is in disrepair.

Due to conflicting information received during interviews conducted with facility staff and residents, and after a review of facility grounds, R1’s electronic MARs and online academy training records, LPA is unable to determine if resident's medication was not administered as prescribed, staff are not properly trained, staff do not answer facility phone, and facility is in disrepair. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegations are unsubstantiated.

An exit interview was conducted with AIT Rhon Hipolito. A copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022

LIC9099 (FAS) - (06/04)

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