306005636-5-6-2026-22-AS-LMOA-DUV72V-20260608211722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 05/06/2026
Date Signed: 05/06/2026 04:18:22 PM

Unsubstantiated

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
04/28/2026 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260428141727

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:	DATE:	05/06/2026
		UNANNOUNCED	TIME BEGAN:	12:16 PM
MET WITH:	Rhon Hipolito		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Facility staff did not meet the personal rights of the residents.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez. LPA met with Executive Director (ED) and Clinical Director (ED) Ruby Racca-Magao and explained the purpose of the inspection.

Complaint alleges Staff 1 (S1) and Staff 2 (S2) did not meet the personal rights of the residents by discussing Resident 1's (R1’s) personal information with other residents.

During the course of the investigation, interviews were conducted with three facility residents and three staff. During their interview, R1 stated S1 and S2 had informed Resident 2 (R2) and Resident 3 (R3) that they had sustained a fall due to being "drunk" or overdosing. Per R1, Staff 3 (S3) also had knowledge of the incident and had witnessed S2 and S3 informing R2 and R3 of their fall. During their interview, R2 denied the allegation and stated facility staff “are the nicest and most professional.” (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

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-20260428141727

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: 05/06/2026

NARRATIVE

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Per R2, R1 personally told them they had taken “too much medicine" and forgot to set the breaks on their wheelchair leading to the fall. R2 stated that after R1 informed them of what had occurred, they told "everybody" and R1 “was upset.” R2 denied S1 or S2 ever discussing R1’s fall with them personally and denied having any knowledge of S1 or S2 ever discussing R1 or R1’s fall with other residents. During their interview, R3 denied S1 or S2 ever discussing R1’s fall with them personally and denied having any knowledge of S1 or S2 ever discussing R1 or their fall with other residents. Per R3, it had been R2 who had informed other residents that R1 had sustained a fall because of their drinking. R3 stated they have overheard staff discussing other residents and the care being provided on more than one occasion, however, R3 unable to identify the staff alleged to have been discussing residents or identify residents alleged to have been discussed. During their interview, Staff 1 (S1) denied ever discussing R1 or R1’s fall with R2 or R3 and denied ever informing R2 or R3 that R1 had been drinking or overdosed. S1 denied having any knowledge of S2 or any other staff discussing R1's or any other resident's personal information with other residents. During their interview, Staff 2 (S2) denied ever discussing R1 or R1’s fall with R2 or R3 and denied ever informing R2 or R3 that R1 had been drinking or overdosed. S2 denied having any knowledge of S1 or any other staff discussing R1's or any other resident's personal information with other residents. During their interview, S3 denied having any knowledge of S1 or S2 discussing R1 or R1's fall amongst themselves or with other residents. S3 denied witnessing or having any knowledge of S1 or S2 discussing R1's drinking with R2 or R3. Per S3, residents gossip amongst each other and that is how information about other residents spreads.

Due to allegation being uncorroborated during interviews conducted, the Department is unable to determine if Facility staff did not meet the personal rights of the residents. Although the above allegation may have happened or is 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.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026

LIC9099 (FAS) - (06/04)

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