306005636-6-20-2023-22-AS-AORZ-CV5TBY-20230828143551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:41:31 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
04/10/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230410155851

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:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	12:28 PM
MET WITH:	Executive Director - Rhonwinn Hipolito		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure that resident's hygiene needs were met
Staff did not ensure that resident was adequately fed
Staff did not respond to resident's call for assistance
Staff do not answer facility telephone
Staff did not obtain medical care for resident in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings for the complaint received on 4/10/23. LPA De Perio explained the purpose of today's visit, was greeted, by Executive Director (ED) Rhonwinn Hipolito.

It was alleged that staff did not ensure that resident's hygiene needs were met. During the physical plant of the facility, LPA observed residents to be clean and that hygiene needs were met. LPA reviewed documents such as the showering schedule and caregiver tasks. 9 interviews were conducted, which consisted of staff, residents, and external parties, of which interviews stated that if a resident refuses of wanting to shower that day, then staff will return the following day and attempt to assist resident with showering. 3 interviews conducted with residents verified that staff do assist with ensuring that hygiene needs are met.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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 4

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
04/10/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230410155851

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:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	12:28 PM
MET WITH:	Executive Director - Rhonwinn Hipolito		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff removed resident's personal items (ringbell camera)

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, by Executive Director (ED) Rhonwinn Hipolito.

It was alleged that staff removed resident's personal items (ringbell camera). During the visit LPA toured the facility and observed the camera installed by the R1 daughter was not removed and in placed at the facility therefore the allegation is unfounded.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with ED Hipolito. A copy of this report was provided and explained.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 22-AS-20230410155851

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: 06/20/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with ED Hipolito. A copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 22-AS-20230410155851

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: 06/20/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

It was alleged that staff did not ensure that resident was adequately fed. During the physical plant of the facility, LPA observe that the facility is supplied with 7-day non-perishable and 2-day perishable food supplies, and also observed residents eating snack. LPA reviewed documents such as the facility menu and meal times. 9 interviews were conducted which consisted of staff, residents and external parties, of which interviews revealed that if a resident refuses of wanting to eat, staff will continue to prompt the resident to eat, come back at a later time, or offer a snack. 1 interview specified "They are always feeding and cooking, cooking and feeding".

It was alleged that staff did not respond to resident's call for assistance. During the physical plant of the facility, LPA tested random call buttons of residents, and out of the 3 resident call buttons that were tested, staff responded. LPA reviewed the resident (R1) physician report. 9 interviews were conducted with consisted of staff, residents and external parties, of which 1 interview with a resident stated "If I need help, they help me", and 8 of the interviews did not corroborate with the allegation by stating that staff do answer the resident's calls.

It was alleged staff do not answer facility telephone. During the physical plant of the facility, LPA observed that the receptionist on duty was answering phone calls at the front desk. LPA also called the facility 3 times on varying dates, of which the calls were answered. 6 out of the 9 interviews verified that the facility does answer the facility telephone, therefore did not corroborate with the allegation.

It was alleged that staff did not obtain medical care for resident in a timely manner. 5 out of the 9 interviews conducted did not corroborate with the allegation by stating that facility does contact medical care (such as 911), of which 1 interview specified "when in doubt we just call 911 to be safe". LPA reviewed R1's physician report and incident reports pertaining to contacting medical care for residents.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations indicated are deemed UNSUBSTANTIATED.

An exit interview was conducted with ED Hipolito. A copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4