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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 07/03/2025
Date Signed: 07/03/2025 02:49:11 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2025 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250624140329
FACILITY NAME:HACIENDA GRANDE SENIOR ASSISTED LIVINGFACILITY NUMBER:
198205024
ADMINISTRATOR:LORENZONA ELVIE MEDINAFACILITY TYPE:
740
ADDRESS:1740 GRAND AVENUETELEPHONE:
(562) 597-7753
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:120CENSUS: 47DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elvie LorenzonaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not prevent resident from engaging in inappropriate interactions with another resident in care.
INVESTIGATION FINDINGS:
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On 7/3/25, at 09:30am, the department conducted an initial complaint visit to the facility and was greeted by Lorenzona Elvie Medina, Administrator. Later joined by Rodrigo Ramos, Licensee. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff/residents, and deliver findings for the allegation mentioned above.

The investigation consisted of the following: The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S5), and residents (R1-R7) from 9:30am-12:00pm. The department received the following documents: Resident Roster (Dated: No Date), Staff Roster (Dated: 11/14/2025), ID Emergency Information (Dated: 10/29/2018, 01/21/2020, 2/28/2021), Physicians Report (Dated: 12/13/2024,12/20/2024, 03/20/2025), Resident Appraisal Information (Dated:04/07/2025, 01/23/2024, 03/12/2024, 03/20/2025), Preplacement Appraisal (Dated: 03/12/2024) and Medication List (Dated: 07/01/2025-07/31/2025), from the facility.

Report Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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 11-AS-20250624140329
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HACIENDA GRANDE SENIOR ASSISTED LIVING
FACILITY NUMBER: 198205024
VISIT DATE: 07/03/2025
NARRATIVE
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The investigation revealed the following: Allegation- Staff did not prevent resident from engaging in inappropriate interactions with another resident in care.

The details of the complaint alleged that a resident in the facility exposed themselves to another resident (R1) in care. On 7/3/25, from 9:30am-12:00pm, the department interviewed staff (S1-S5) and residents (R1-R7) regarding the allegation. All staff (S1-S5) denied the allegation that Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. Staff stated that they did not witness any inappropriate interactions between residents that was sexual in nature. They further state that no other resident to their knowledge has been observed exposing themselves to other residents or staff. They state that a resident (R1) in the facility has been known to fabricate and have delusions that people were doing things to them which turned out not to be true, once investigated. Staff stated that (R1) has a mental condition that brings about paranoid delusions, agitated behavior, and psychosis.

The department interviewed residents (R1-R7) about the allegation and 6 of 7 residents that were interviewed, denied any knowledge of inappropriate behaviors from residents that were sexual in nature. They stated that they have not witnessed or were aware of anyone exposing themselves in the facility. While resident (R1) declined to participate in the interview.

The department reviewed the Physicians Report (Dated: 03/20/2025), Resident Appraisal (Dated: 03/20/2025), Medication List (Dated: 07/01/2025-07/31/2025), and Preplacement Appraisal (Dated: 03/12/2024) for (R1) and observed that the resident has a medical history of schizoaffective behavior, psychosis, and paranoia. The department also observed that the resident is taking aripiprazole and lithium medication, which is used to treat psychosis and bipolar disorder. Symptoms of psychosis include delusions, hallucinations, and agitation. During an episode of psychosis, a person’s thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not, according to the National Institute of Mental Health website www.nimh.nih.gov .

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur because of neglect, therefore the allegation is Unsubstantiated.

No citations were issued.

An exit interview was conducted with Lorenzona Elvie Medina, Administrator, and a hard copy of this Complaint Investigation Report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
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