306005636-11-20-2023-22-AS-AORZ-CYNSTE-20231219130926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 11/20/2023
Date Signed: 11/20/2023 02:05:09 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
09/29/2023 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230929113543

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: 106	DATE:	11/20/2023
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Rhonwinn Hipolito, Administrator		TIME COMPLETED:	02:08 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Facility staff did not answer resident's calls for assistance.

INVESTIGATION FINDINGS:

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

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz and (LPA) Jenifer Tirre conducted a joint unannounced visit for the purpose to deliver findings for complaint allegation listed above. LPA Quiroz and LPA Tirre were greeted and granted entry by Front desk receptionist and met with Executive Director (ED) Rhonwinn Hipolito and discussed purpose of today's visit.
The ten day inspection visit was conducted on 10/3/2023 and a complaint follow up inspection visit was conducted on 10/17/2023.
During the course of the investigation, LPA Quiroz conducted interviews with interviewees consisting of staff, residents and other witnesses and documentation review but not limited to physician reports, needs and services plans and facility call log report.
Regarding the allegation "Facility staff did not answer resident's calls for assistance" the investigation revealed the following: Interviews conducted with interviewees consisting of staff and residents concluded that there is enough staff working at the facility and staff are responding to call lights in a timely manner.
CONTINUED ON LIC 9099-C 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: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

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 2

Control Number 22-AS-20230929113543

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: 11/20/2023

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

CONTINUED... During the course of the investigation, Eleven of eleven interviewees indicated staff respond to call lights and assistance requests timely. (ED) Hipolito indicated staff conduct routinely checks on residents every 2 hours or depending on their needs but do not keep a record of routinely checks.
During inspection visit conducted on 10/17/2023 on or about 3:23pm , LPA Quiroz conducted tour of Resident 1 (R1) and Resident 2 (R2) bedroom area. During inspection visit, LPA Quiroz observed call light button covered in duct tape and observed furniture obstructing call light access. Five of five staff interviewed indicated frequent routine checks attempts on (R1) and (R2) during their work shift stating "But they never open the door. We hear they're in there, but (R2) refuses all help and assistance for (R1)."
During facility inspection visits, LPA Quiroz observed a table located outside of (R1) and (R2)s bedroom area, interviews conducted with eleven of eleven interviewees concluded that the table outside of (R1) and (R2)s bedroom area was identified as a place where staff is requested by (R2) to drop off any items such as mail, packages, trash bags or door dash food services.
Documentation review of the facility call log report for (R1) and (R2) indicate no call request activity during the time period of 1/01/2023 - 10/17/2023.
The Department has investigated the complaint alleging that staff did not answer resident's calls for assistance. Therefore based on the preponderance of evidence gathered through interviews, documentation review and observations conducted by LPA Quiroz, the allegation that the "Facility staff did not answer resident's calls for assistance," is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during today's visit.
An exit interview was conducted with (ED) Hipolito and a copy of today's report and LIC 811- Confidential Names were provided.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2