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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 12/22/2023
Date Signed: 12/22/2023 03:36:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
06/27/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230627074740
FACILITY NAME:MAINPLACE SENIOR LIVINGFACILITY NUMBER:
306005636
ADMINISTRATOR:RHONWINN HIPOLITOFACILITY TYPE:
740
ADDRESS:1800 1832 W. CULVER AVENUETELEPHONE:
(714) 978-2534
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:153CENSUS: 105DATE:
12/22/2023
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Elizabeth Bran Mendoza-Director of Sales and Marketing ,Rhonwinn Hipolito-Executive DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility did not report theft of resident's personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on 06/27/23. LPA was greeted and granted entry into the facility by Receptionist Noemi Otero. LPA explained the reason for the visit. Director of Sales and Marketing Elizabeth Bran Mendoza arrived shortly after.

This agency has investigated the complaint alleging that the facility did not report theft of resident's personal belongings. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: One of ten individuals interviewed corroborated the allegation. Records reviewed by LPA Ramirez included the Mainplace Senior Living Theft and Loss Policy. Per Theft and Loss Policy “Lost or stolen property with a value of $100.00 or more will be reported to law enforcement within thirty-six (36) hours of the discovery of the loss or theft.” Records reviewed by LPA Ramirez included the Orange Police Department (OPD) Incident dated 06/30/23
CONTINUED ON LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
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 5
Control Number 22-AS-20230627074740
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MAINPLACE SENIOR LIVING
FACILITY NUMBER: 306005636
VISIT DATE: 12/22/2023
NARRATIVE
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for Resident 1 (R1). Per OPD Incident report R1 reported that they discovered that $400 was missing from their room. Per OPD Incident report the date/time item was discovered missing is listed as 06/12/23 at 4:00 PM. During the course of the interviews ED stated that a Police report was filed with the OPD on 06/30/23. The facility filed a Police report 18 days after the discovery of R1’s stolen property. During the interviews with residents, R1 reported that they notified management, but that management did not file a Police report.

Based on the interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: facility did not report theft of resident's personal belongings is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D.


An exit interview was conducted with Wellness Director (WD) Ruby Raccamagao and a copy of this report along with the Appeal Rights were provided at the time of this visit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20230627074740
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: MAINPLACE SENIOR LIVING
FACILITY NUMBER: 306005636
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/27/2023
Section Cited
CCR
87218(a)(3)(i)
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Theft and Loss (a) The licensee shall ensure… (i) Reports to the local law enforcement agency within 36 hours when… property with a then current value of one hundred dollars ($100) or more has been stolen. This requirement is not met as evidenced by: Based on interviews and
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Licensee/Administrator agrees to read regulation and sign a statement of understanding and forward proof to LPA by POC due date.
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LPA observations the facility did not report R1’s stolen property with a value of $400.00 to Law Enforcement within 36 hours as documented per facility’s Plan of Operation. This poses a potential risk to resident’s health and safety while in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
06/27/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230627074740

FACILITY NAME:MAINPLACE SENIOR LIVINGFACILITY NUMBER:
306005636
ADMINISTRATOR:RHONWINN HIPOLITOFACILITY TYPE:
740
ADDRESS:1800 1832 W. CULVER AVENUETELEPHONE:
(714) 978-2534
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:153CENSUS: 105DATE:
12/22/2023
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Elizabeth Bran Mendoza-Community Liaison ,Rhonwinn Hipolito-Executive DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff are going through resident's personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on 06/27/23. LPA was greeted and granted entry into the facility by Receptionist Noemi Otero. LPA explained the reason for the visit. Executive Director (ED) Rhonwinn Hipolito arrived shortly after.

This agency has investigated the complaint alleging that staff are going through resident's personal belongings. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Nine of ten individuals interviewed denied the allegation. During interviews with the residents, Resident 1 (R1) reported that staff do not enter their bedroom when they are not home, and that staff have not taken valuables and/or money from their bedroom. Per R2 staff are nice, attentive, respectful and would not go through the residents’ personal belongings. During the interviews with staff, Staff 1 (S1) reported that she has not witnessed staff taking valuables or
CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20230627074740
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MAINPLACE SENIOR LIVING
FACILITY NUMBER: 306005636
VISIT DATE: 12/22/2023
NARRATIVE
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money from the resident bedrooms and stated that staff are good people. Per S2 staff never take resident’s personal belongings because it is a job policy and because it is not correct. During the course of the interviews ED stated that staff do not go through the residents’ personal belongings and reported that residents lock their bedroom when they go out.

Based on LPA's observations and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with Wellness Director (WD) Ruby Raccamagao, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5