306005636-10-3-2023-22-AS-AORZ-CX5MXC-20231031095941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 10/03/2023
Date Signed: 10/03/2023 05:22:31 PM

Unfounded

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
06/06/2023 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230606092904

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: 104	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Ronwinn "Rhon" Hipolito, Executive Director		TIME COMPLETED:	05:22 PM

ALLEGATION(S):

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-Facility does not meet resident’s needs.
-Floor in resident room is not cleaned properly.

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to conduct additional interviews and deliver findings for complaint allegations listed above. LPA Quiroz was greeted and met with Executive Director (ED) Rhonwinn "Rhon" Hipolito and discussed purpose of today's visit. The 10 day visit was conducted on 6/12/2023 by LPA Quiroz.
During the course of the investigation, LPA Quiroz conducted interviews with interviewees consisting of staff, residents and other witnesses.
Regarding the allegation "Facility does not meet resident’s needs," the investigation revealed the following: Nine of ten interviewees denied the allegation. Six of six residents denied the allegation indicating staff respond timely when called for assistance. Resident 2 (R2) indicated "My room mate just wants to get rid of me and wants his own private room."
CONTINUED ON NEXT PAGE...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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-20230606092904

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: 10/03/2023

NARRATIVE

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Regarding the allegation "Floor in resident room is not cleaned properly," the investigation revealed the following: Nine of ten interviewees denied the allegation indicating Maintenance Director conducts carpet cleaning when requested. Health and Wellness Director Mims indicated "There's a carpet cleaning request list in the front lobby, so residents can call and request carpet cleaning and it'll get done by the Maintenance Director timely." (R2) indicated "My room mate wants to get rid of me, so he keeps saying I'm having accidents and not being cleaned." Five of six residents indicated "Staff disinfect the carpet immediately when needed due to sanitary reasons." Health and Wellness Director Mims indicated "(R1) has requested laminate floor in bedroom area and he's on our list for floor already." Executive Director (ED) Rhon Hipolito indicated laminated floor was installed in (R1) and (R2)s bedroom area on July 19, 2023.
Therefore based on the preponderance of evidence gathered through interviews and observations conducted by LPA Quiroz, the allegation that the "Facility does not meet resident’s needs" and "Floor in resident room is not cleaned properly" are deemed UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. This agency has investigated this complaint.

No deficiencies cited during today's visit.

An exit interview was conducted with (ED) Rhon Hipolito and a copy of report was provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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