306005636-4-10-2024-22-AS-LMOA-D5SNTS-20240531104509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 04/10/2024
Date Signed: 04/10/2024 02:44:42 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
01/12/2024 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240112162107

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: 110	DATE:	04/10/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Rhon Hipolito - Executive Director		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Facility did not have appropriate staffing to meet residents needs.
Facility does not have required postings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced follow up visit to the facility to complete additional interviews and deliver the findings on the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit.

The complaint investigation consisted of interviews with facility staff, residents, a resident family member, a witness, and document review. Two additional witnesses were contacted but could not be reached.

Regarding the complaint allegation: Facility did not have appropriate staffing to meet residents needs.

During the investigation interviews were conducted with facility staff, residents, and witnesses for a total of nine interviews.

Continued on LIC9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024

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-20240112162107

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: 04/10/2024

NARRATIVE

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Two additional interviews were attempted, but witnesses could not be reached. Regarding the allegation above, 7 of 9 individual’s interviewed denied the complaint allegation. According to Staff 2 (S2) there is enough staff and 2 new staff members were just hired. During the interview, S2 stated two interviews were scheduled for later in the afternoon (April 10, 2024). S2 says the census is growing so new employees have been hired. S3 says, there is enough staff, but it doesn’t hurt to have more, as people call off sometime. All residents interviewed said there is enough staff in the facility.

Regarding the complaint allegation: Facility does not have required postings.

During the investigation LPA Haley observed the required PUB 475 See Something Say Something poster hanging on the wall as soon as you enter the Assisted living portion of the facility as well as one in the Memory Care Unit. The Ombudsman’s posters were observed near the elevator in the Assisted Living Unit, and in the Memory Care Unit. Photos were taken of the postings.

Based on the information gathered through interviews and observations, the following allegations: Facility did not have appropriate staffing to meet residents needs, and Facility does not have required postings, are UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2024

LIC9099 (FAS) - (06/04)

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