306005636-7-26-2022-22-AS-SSAS-CGXV9F-20220803161417

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 07/26/2022
Date Signed: 07/26/2022 02:49:28 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
10/06/2020 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201006092817

FACILITY NAME:	MAINPLACE SENIOR LIVING		FACILITY NUMBER:	306005636
ADMINISTRATOR:	MICHAEL MARION		FACILITY TYPE:	740
ADDRESS:	1800 1832 W. CULVER AVENUE		TELEPHONE:	(714) 978-2534
CITY:	ORANGE	STATE: CA	ZIP CODE:	92868
CAPACITY:	153	CENSUS: 73	DATE:	07/26/2022
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Administrator Phat Nguyen		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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9

Resident touched inappropriately by another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michelle Reed arrived at the facility to deliver the findings for the above complaint allegation. Upon arrival, LPA met with Administrator Phat Nguyen. The investigation consisted of interviews with the Administrator, staff, and resident as well as documentation from the facility. The following was determined:

R1 was admitted into the facility on 9/28/19. On 10/6/20 R1 reported that R2 grabbed R1’s buttocks on two different occasions while staff were walking R1 to the dining room for breakfast. R2 denied the allegations and staff interviewed also denied that the incidents took place.
Based upon interviews and a review of records, the allegations above are unfounded, meaning the allegation is false, could not have happened or is without a reasonable basis. We have therefore dismissed the complaint allegation.

An exit interview was conducted and a copy of this report and appeal rights were provided to Administrator Phat Nguyen.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle Reed	TELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

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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