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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005636
Report Date: 12/16/2025
Date Signed: 12/16/2025 09:39:09 AM

Unfounded


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
06/30/2023 and conducted by Evaluator Brandon Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230630114211
FACILITY NAME:MAINPLACE SENIOR LIVINGFACILITY NUMBER:
306005636
ADMINISTRATOR:RHONWINN HIPOLITOFACILITY TYPE:
740
ADDRESS:1800 1832 W. CULVER AVENUETELEPHONE:
(714) 978-2534
CITY:ORANGESTATE: CAZIP CODE:
92868
CAPACITY:153CENSUS: 121DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Wellness Coordinator Ervin NarioTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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Staff refused to administer medication to resident
INVESTIGATION FINDINGS:
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On December 16, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Wellness Coordinator (WC) Ervin Nario later arrived to assist with the visit.

During the course of the investigation, the Department inspected the facility, interviewed residents and staff, reviewed and obtained pertinent documents to the complaint such as current staff roster, current resident roster, and resident records. Regarding the allegation that, staff refused to administer medication to resident, the following has been concluded: It was alleged that a facility staff, Person #1 (P1) refused to administer medication to Resident #1 (R1). However, the Department observed that P1 was not an employee at the facility and the facility did not have any record of P1 ever being a staff at the facility. The Department conducted an interview with R1 who denied the allegation and stated that staff never refused to administer her medication. CONTINUED ON LIC9099-C
Unfounded
Estimated Days of Completion: 90
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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-20230630114211
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: 12/16/2025
NARRATIVE
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R1 stated that there was an incident where she became upset with a facility staff because they ran out of one of her medications, however, they were able to do an emergency refill with the Pharmacy and she has not had any issues since. The Department additionally conducted five resident interviews. Five out of the five residents interviewed denied any issues with their medication and denied staff ever refusing to administer their medication. All five residents interviewed stated that they receive their medication on time and that they do not have any concerns about the staff administering the medication. The Department also conducted four staff interviews. Four out of the four staff interviewed denied ever observing or witnessing a staff refusing to administer medication to a resident.

The Department observed that there was an Unusual Incident/Injury Report (UIIR) received by the Orange County Regional Office on June 6, 2023. The UIIR contradicts the complaint allegation and describes R1 being verbally and physically to staff due to her Primary Care Physician (PCP) being unable to order her medications.

Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Wellness Coordinator Ervin Nario and a copy of the report was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
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