198205024-5-21-2021-11-AS-MCAA-C5SUEP-20210811153124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 05/21/2021
Date Signed: 05/21/2021 03:42:49 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
05/14/2021 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20210514124802

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: 44	DATE:	05/21/2021
		UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	Elvie Medina		TIME COMPLETED:	03:47 PM

ALLEGATION(S):

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Facility Showers are Unsanitary
Staff Are not treating residents with Dignatity and respect

INVESTIGATION FINDINGS:

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05/21/21 Licensing Program Analyst LPA/Jordan initiated an unannouced 10 complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Administrator Lorenzona Medina.

LPA Jordan explained the reason for the visit, and allegations were discussed with the Administrator.

Investigation consisted of conducted interviews with (6) six residents in care, (2) two House Keeping staff, Administrator, toured resident rooms checked shower drainage, and requested documents pertaining to the allegations. (Facesheets, Resident Roster,Housekeeping Schedule)

Continued on page 9099 C

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: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

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-20210514124802

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: 05/21/2021

NARRATIVE

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Regarding allegation: Facility's showers are unsanitary.

LPA interviewed residents and asked if their bathroom showers or sinks were working properly, and being cleaned. Resident all generally stated that they felt their bathrooms were sanitary, and that staff regularly come in to clean on a weekly basis if not daily. Some Residents indicated that if drains are not working properly, they notify management or maintenance and it’s taken care of quickly. LPA Jordan sampled 5 rooms and tested the shower drains and found that all drains were working properly and that shower basins were clean, and sanitary. Based on LPA interviews, and observation 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.”

Regarding allegation: Facility staff do not treat residents with dignity and respect

LPA interviewed residents and asked if staff had spoken inappropriately, disrespectfully, or felt staff were being mean, and all residents generally answer no. Interviewed Residents generally stated that staff were kind, and had no issues of mistreatment. LPA interview admin and asked if there were any complaints of staff being disrespectful/mean to residents, admin stated no, and that disrespectful / mean behavior from staff is not acceptable. Based on LPA interviews 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 given to administrator.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021

LIC9099 (FAS) - (06/04)

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