198205024-12-20-2021-11-AS-MCAA-CB8R73-20220201114540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 12/20/2021
Date Signed: 12/20/2021 01:41:11 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
12/16/2021 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20211216105735

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: 43	DATE:	12/20/2021
		UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Lorenzona "Elvie" Medina		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident was spoken to inappropriately while in care.
Resident was not provided assistance with eating while in care.

INVESTIGATION FINDINGS:

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On 12/20/21 Licensing Program Analyst (LPA) Jade Jordan, conducted an Unannounced complaint visit. Regarding the allegation(s) above. The LPA was met by Facility Administrator Lorenzona Medina,And the purpose of the visit was explained.
The Investigation consisted of the following: Interviews with Staff and Residents in Care, Record Review, and Physical tour.
Regarding Allegation: Resident was spoken to inappropriately while in care.
Interviews with staff, including Administrator revealed that they have not witnessed any residents in care being spoken to inappropriately by other staff, nor have any residents complained to them about being spoken to inappropriately. Interviews with residents 1-3 (R1, R2,R3,R4) revealed that R1-R3 generally stated that they receive assistance, and that staff are speaking, and treating them with respect. Based on interviews conducted 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.

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: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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-20211216105735

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: 12/20/2021

NARRATIVE

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Regarding Allegation: Resident was not provided assistance with eating while in care.
Interview with Staff revealed that there are 4 residents In care who need assistance with eating. Interviews with staff revealed that Residents 1-3 can feed themselves but need assistance to make sure That they do not aspirate. Staff stated that they stay in the room with the resident when food is provided. Interviews with residents in care revealed that those who need assistance with eating do receive it, and that staff stay with them. Therefore; based on interviews conducted, and record review 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.

An Exit interview was conducted, and a copy of this report was provided. No citations were issued during this visit.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

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