198205024-8-14-2026-11-AS-PMAA-DXSNMC-20260910103456

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 08/14/2026
Date Signed: 08/14/2026 02:55:40 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
08/07/2026 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 11-AS-20260807135218

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: 57	DATE:	08/14/2026
		UNANNOUNCED	TIME BEGAN:	12:04 PM
MET WITH:	Rodrigo Ramos		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee did not surrender resident’s cash resources to their responsible party upon discharge

INVESTIGATION FINDINGS:

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On August 14, 2026, the Department of Social Services (DSS) staff conducted an initial unannounced complaint visit at the facility to investigate the above allegation and to deliver the findings. The department was greeted by Rodrigo Ramos, and the purpose of the visit was explained.

The investigation consisted of the following

On August 14, 2026, the Department obtained the following pertinent documents: R1’s Admission Agreement (dated 4/14/26), Payment invoice to POA (dated 7/1/26), copy of check payable to R1’s Power of Attorney (POA) and copy of proof mailing of the payment.

On August 14, 2026, the Department interviewed Chief Executive Officer (A1)
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026

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-20260807135218

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: 08/14/2026

NARRATIVE

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The investigation revealed the following

Allegation: Licensee did not surrender resident’s cash resources to their responsible party upon discharge

The detail of complaint alleges on July 1, 2026, R1 was not going to return to the facility due to requiring a higher level of care. The Power of Attorney (POA) asked Licensee for the cash resources the facility was safeguarding, and as of the date of complaint, the funds still has not been released

On August 14, 2026, at 1:00 p.m., the Department interviewed the Chief Executive Officer (A1) regarding the allegation that the Licensee did not surrender the resident’s cash resources to the responsible party upon discharge. A1 denied the allegation, stating that the resident’s cash resources were in the process of being returned to the Power of Attorney (POA). A1 further explained that there were no issues regarding the return of the funds.

On August 14, 2026, the Department also reviewed and evaluated the following documents: a payment invoice (dated 7/1/26) and a copy of the check payable to the POA (dated 8/14/26). These documents confirm that the funds are being returned, and the payment matter has been resolved.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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.

Exit interview conducted with Rodrigo Ramos. There were no deficiencies cited during today's visit. Copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2026

LIC9099 (FAS) - (06/04)

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