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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 08/27/2025
Date Signed: 08/27/2025 04:58:31 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
08/20/2025 and conducted by Evaluator Troy Watson
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250820150324
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: 48DATE:
08/27/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator - Lorenzona MedinaTIME COMPLETED:
04:58 PM
ALLEGATION(S):
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Staff speak to resident inappropriately.
INVESTIGATION FINDINGS:
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On 08/27/2025 Licensing Program Analyst (LPA) Troy Watson made an unannounced complaint visit to the above listed facility. LPA Watson was greeted by the Administrator Lorenzona Medina and explained the purpose of this visit is to investigate the allegation mentioned above.

The investigation consisted of the following:

LPA Watson conducted interviews with residents and staff. LPA Watson requested, obtained and reviewed the following documents: Resident Roster, Employee Roster, Physicians Reports, Resident Appraisals, and Incident Report, for Resident#1-Residents#6 (R1-R6). On 08/27/2025 LPA Watson conducted interviews with Residents #1 - Residents #6 (R1-R6) and Staff #1- Staff #6 (S1-S6). LPA Watson toured the facility with administrator Lorenzona Medina and observed the facility clean and in good repair.

CONTINUED ON LIC9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
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-20250820150324
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: 08/27/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Staff speak to residents inappropriately.

On 08/27/2025 LPA Watson interviewed Residents #1 - Residents #6 (R1-R6). Of those interviewed, 6 out of 6 staff denied the above allegation. On 08/27/2025 LPA Watson conducted interviews with Staff#1 - Staff #6 (S1-S6). Of those interviewed, 5 out of 6 staff denied the above allegation. LPA Watson requested, and obtained an Unusual Incident Report and it showed no documented evidence that residents were spoken to inappropriately by staff. Based on interviews, records,observations there is insufficient evidence to support the allegation: Staff speak to residents inappropriately. 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, therefore the allegation is Unsubstantiated.

An exit interview was conducted with the Administrator Lorenzona Medina and a copy of this report was provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2