198205024-3-6-2024-11-AS-RORN-D3KMLT-20240321094251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 03/06/2024
Date Signed: 03/06/2024 05:59:57 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
02/29/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20240229165254

FACILITY NAME:	HACIENDA GRANDE SENIOR ASSISTED LIVING		FACILITY NUMBER:	198205024
ADMINISTRATOR:	LORENZONA ELVIE MEDINA		FACILITY TYPE:	740
ADDRESS:	1740 GRAND AVENUE		TELEPHONE:	(562) 597-7753
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY:	120	CENSUS: 46	DATE:	03/06/2024
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Administrator Lorenzona Medina		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are opening residents mail.
Facility staff are asking residents for money outside of monthly rent fees.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 03/06/24 at 9:00 a.m. licensing program analyst (LPA) Lizeth Villegas conducted an initial complaint visit regarding the allegations above. LPA met with Administrator Lorenzona Medina as the purpose of the visit was explained. LPA later met with Licensee Rodrigo Ramos.

The investigation consisted of the following: On 03/06/24 LPA obtained copies of the following Resident #1, #7, and #8's (R1,R7,R8) identification and emergency information form, physician report, admission agreement, rent invoices for January-March 2024, and a list of all residents who can manage their own mail. On 03/06/24 LPA interviewed Administrator (AD), Licensee (L1), staff #1-3 (S1-S3), and Residents # 2-6 (R2-R6).
The investigation revealed the following:
Allegation: Facility staff are opening resident’s mail.
It is being alleged that facility staff have opened mail from social security without consent prior to providing the mail to the resident. On 03/06/24 LPA interviewed AD regarding the above allegation, AD denied the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 11-AS-20240229165254

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: 03/06/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

allegation above. Per AD, mail is only opened when it is addressed to Hacienda Grande Senior assisted living. On 03/06/24 LPA interviewed L1 regarding the allegation above, L1 stated that social security mail is opened if the mail is addressed directly to Hacienda Grande Senior Assisted Living. On 03/06/24 LPA interviewed S1-S3 regarding the above allegation, 1 of 3 staff interviewed reported that all mail is sealed when provided to a resident, 2 of the 3 staff interviewed reported that they have no knowledge of the mail procedures. On 03/06/24 LPA interviewed R2-R6 regarding the allegation above, 5 of 5 residents interviewed denied the allegation above reporting they have not had any issues with obtaining their mail. On 03/06/24 LPA was unable to interview R1, R1 whereabouts are unknown at this time.

Allegation: Facility staff are asking residents for money outside of monthly rent fees.

It is being alleged that facility staff are asking resident for resident’s debt card and resident refused. Facility staff proceeded to ask resident to get in staff’s car to withdraw money. Resident refused. On 03/06/24 LPA interviewed AD regarding the above allegation, AD denied the allegation above. AD continued to state that L1 will speak to residents and residents POA if the months rents was not paid. On 03/06/24 LPA interviewed L1 regarding the allegation above, L1 denied the allegation above and reported POA’s are contacted when rent payment has not been made. 03/06/24 LPA interviewed S1-S3 regarding the above allegation, 3 of 3 staff interviewed denied the allegation above. On 03/06/24 LPA interviewed R2-R6 regarding the allegation above, 5 of 5 residents interviewed denied the allegation above and reported the facility does not handle any of their financial resources. On 03/06/24 LPA was unable to interview R1, R1 whereabouts are unknown at this time.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations and Unsubstantiated.

Exit interview conducted with Licensee Rodrigo Ramos, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2