306005636-6-21-2024-22-AS-AJLO-D87Q6J-20240816115334

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 06/21/2024
Date Signed: 06/21/2024 03:14:26 PM

Substantiated

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
06/18/2024 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240618101708

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: 111	DATE:	06/21/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Administrator in Training, Charlie Marinko Wellness Director, Ruby Racca-Magao		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee does not ensure that staff are adequately trained.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Administrator in Training (ADT) Charlie Marinko and discussed the purpose of the inspection.

During the visit, LPA interviewed six staff and conducted record review of eight direct care staff training files.
Upon direct care staff file review, LPA observed eight of eight direct care staff training records did not contain 40 hours of training; consisting of 20 hours, including six hours specific to dementia care, and four hours specific to postural supports, restricted health conditions, and hospice care before working independently with residents, and the remaining 20 hours, including six hours specific to dementia care completed within the first four weeks of employment, as required by regulation.

During interviews, six out of six staff confirmed they have conducted training online, as well as hands-on and shadowing training pertaining to providing direct care and supervision to residents. (Cont. LIC9099-C)

Substantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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-20240618101708

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: 06/21/2024

NARRATIVE

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Three of six staff confirmed they conducted first aid training and training was conducted on-site at the facility. One of six staff stated they had completed first aid training at their previous employment and personally provided LPA with a digital certificate of training completed. Two of six staff denied they have received first aid training. Facility was unable to provide LPA with a copy of first aid training cards for five of eight staff.

Based on staff record review and interviews conducted, LPA determined that Licensee does not ensure that staff are adequately trained. The preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of regulations. (See LIC9099-D).

An exit interview was conducted with Wellness Director (WD) Ruby Racca-Magao and Community Liaison Elizabeth Mendoza. A copy of this report, and appeal rights were left at the facility.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20240618101708

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/21/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/19/2024 Section Cited CCR 87411(c)(1)	1 2 3 4 5 6 7	Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidence by:	1 2 3 4 5 6 7	WD stated direct care staff would immediately be provided with first aid training and proof provided to LPA via email by POC.
	8 9 10 11 12 13 14	The licensee did not comply with the section cited above in five of eight care staff files which poses a potenital safety risk to persons in care.	8 9 10 11 12 13 14
Type B 07/19/2024 Section Cited HSC 1569.625(b)(1)	1 2 3 4 5 6 7	...20 hours, including six hours specific to dementia care... and four hours specific to postural supports, restricted health conditions, and hospice care.. before working... with residents.. remaining 20 hours... include six hours specific to dementia care and shall be completed within	1 2 3 4 5 6 7	WD stated required staff training will begin to be conducted immediately. WD stated they will submit proof to LPA via email by POC date.
	8 9 10 11 12 13 14	the first four weeks of employment... This requirement is not be as evidence by: Based on record review, the licensee did not comply with the section cited above in eight out of eight care staff files, which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14

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: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Claudia Gutierrez	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC9099 (FAS) - (06/04)

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