198205024-2-3-2021-11-AS-MCAA-BYSSJG-20210304125503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 02/03/2021
Date Signed: 02/03/2021 03:42:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2021 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20210125102849

FACILITY NAME:	HACIENDA GRANDE SENIOR ASSISTED LIVING		FACILITY NUMBER:	198205024
ADMINISTRATOR:	MARIANNE A HODEL		FACILITY TYPE:	740
ADDRESS:	1740 GRAND AVENUE		TELEPHONE:	(562) 597-7753
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY:	120	CENSUS: 47	DATE:	02/03/2021
		UNANNOUNCED	TIME BEGAN:	11:48 AM
MET WITH:	Lorenzona Medina administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff are not providing appropriate care and supervision to resident
Resident's personal items have gone missing

INVESTIGATION FINDINGS:

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02/18/21 Licensing Program Analyst LPA/Jordan initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Lorenzona Medina, the Administrator.
LPA Jordan conducted a virtual video call with the Administrator and discussed the above allegation(s). During the video call, LPA Jordan conducted interviews with (5) five residents in care, Administrator, and requested documents pertaining to the allegations. (Facesheets, Personal items audit)

Continued on page 9099 C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021

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 11-AS-20210125102849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HACIENDA GRANDE SENIOR ASSISTED LIVING	FACILITY NUMBER: 198205024
	VISIT DATE: 02/03/2021

NARRATIVE

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Regarding allegation: Staff are not providing appropriate care and supervision to resident
LPA interviewed residents and asked if they felt that staff were not providing appropriate care, Residents in care Generally stated no, were generally happy with the care and supervision that they had been provided by staff of the facility. Therefore based on resident interviews the LPA finds that; “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Regarding allegation: Resident's personal items have gone missing
LPA interviewed residents in care, and asked if they had personal belongings that were taken from them in their room without their permission. Residents in care Generally stated no. Lpa asked if Residents in care any personal items had missing. Residents in care generally stated no items missing and that no one was taking anything from them without their permission. Therefore Based on resident interview LPA finds that
“Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

An exit interview was conducted, and a copy of this report was given to administrator.
Advised to sign copy of report and send back via email jade.jordan@dss.ca.gov or fax 323-981-1781

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2021

LIC9099 (FAS) - (06/04)

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