306005636-1-31-2024-22-AS-AJLO-D2VT5S-20240228132558

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 01/31/2024
Date Signed: 01/31/2024 04:13:53 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
08/09/2022 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220809112719

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: 108	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	03:01 PM
MET WITH:	Business Office Manager, Chasidy Washington		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility windows are not secured.

Facility gate is not secured.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Claudia Gutierrez conducted an unannounced Complaint Investigation for the purpose of delivering findings regarding the allegations mentioned above. LPA met with Business Office Manager, Chasidy Washington and Community Liason, Elizabeth Mendoza.

Interviews were conducted with staff and Resident 1 (R1) regarding facility windows not being secured. Two out of three staff stated that facility windows are secure, have a latch, and a screen. One out of three staff stated the window in the resident room where R1 was thought to have exited, was not screened on at least one occasion. All three staff, however, confirmed R1 did not exit through their own bedroom window. R1 entered room 306, which was a different resident’s room, and exited through that window. On 8/16/22, LPA conducted initial complaint investigation inspection at the facility. At 3:50 p.m. LPA conducted a tour of the inside and outside of the facility. LPA observed facility windows within the memory care unit to be latching and had an audible alarm. (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: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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-20220809112719

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: 01/31/2024

NARRATIVE

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LPA tested the alarm on window identified as R1’s possible exit point, the window was observed to be three to four feet off the ground and alarm was found to be operable. LPA determined R1 would have entered a bedroom not assigned to them, approached the window, and climbed the three to four feet off the ground to exit through the window. During their interview, R1 was unable to confirm or deny if the window was secure.

Interviews were conducted with Staff and Resident 1 regarding allegation facility gate is not secure. Two out of three staff stated that the gate is secure, and it would be difficult for a resident to exit that way. One out of three staff stated the gate is not secure and does not lock. During a tour of the facility, LPA observed gate to be self-latching with an operable lock; the gate has a doorknob that locks from the inside and requires a key to be opened from the outside. The gate is designed to keep people out and is not meant to lock residents or others in. LPA noted that there are no patios or doors that lead to that gate. The only way to access the gate from inside the facility would be to exit through a window. During their interview, R1 could not corroborate the allegation and was unable to confirm or deny is facility gate is secure.

Due to conflicting information received during interviews conducted and after a review of facility grounds, LPA is unable to determine if facility windows were not secured or if facility gate was not secured. 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 allegation is unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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