198205024-4-17-2026-11-AS-SCIS-DTRSN9-20260504140104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 04/15/2026
Date Signed: 04/17/2026 06:30:17 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, 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
07/07/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20250707125514

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: 76	DATE:	04/15/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lorenzona Elvie Medina		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.
Staff did not give a resident water.
Staff did not prevent a resident from eloping from the facility.
Staff force residents to go to bed at an unreasonable time.

INVESTIGATION FINDINGS:

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The purpose of the visit is to provide additional information not included in the report dated January 26, 2026; the findings remain the same. On April 15, 2026, Licensing Program Analyst (LPA) Pamela Bunker conducted a subsequent visit to gather information regarding the above allegations. LPA met with Lorenzona Medina, Administrator, and explained the purpose of the visit. LPA was granted entry to the facility.
The investigation consisted of the following: On January 26,2026, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 11/14/2024), Resident Roster (dated 01/26/2026), Admission Agreement (dated 03/28/2023), Identification and Emergency Information (dated 03/28/2023), Physician’s Report (dated 03/28/2023), Medical Assessment (dated 03/28/2023), Medication Administration Records (MARs) (dated 07/01/2025-07/31/2025), Residential Appraisal & Needs and Services Plan (dated 09/25/2024), Functional Capability Assessment (dated 03/28/2023), Preplacement Appraisal Information (dated 03/299/2023), Personal Rights (dated 03/28/2023), Consent Forms (dated 03/28/2023), Menu (dated 05/01/2025-07/312025), Unusual Incident Report (dated 02/16/2024 & 02/10/2025), In-Service Training (dated 09/24/2024, 09/26/2024,11/1/2024, 11/11/2024, 02/20/2025, and 08/18/2025).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

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 4

Control Number 11-AS-20250707125514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HACIENDA GRANDE SENIOR ASSISTED LIVING	FACILITY NUMBER: 198205024
	VISIT DATE: 04/15/2026

NARRATIVE

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Continued LIC9099-C page 2.

Sign In and Out Sheet (dated 01/2025--02/2025), and Flex Note (2/17/2025, 02/21/2025, 03/01/2025, 03/02/2025, and 03/04/2025.

On 01/21/2026 & 01/26/2026, between 11:30 a.m. and 3:30 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#4 (S1–S4) and with residents #2–#6 (R2–R6). Resident #1 (R1) was unavailable for an interview as they no longer reside at the facility. R1 transferring to a higher level of care facility.

The investigation revealed the following.
Allegation: Staff did not safeguard the resident’s personal belongings.

LPA Bunker interviewed staff members S1–S4. All four staff (4 out of 4) stated that facility staff safeguard residents’ personal belongings. They explained that the responsible party, not facility staff, handles R1’s laundry and is responsible for putting away the resident’s clothing and personal items. The responsible party reported that a pillowcase and sweater were missing. However, all four staff members 4 out of 4 stated they searched R1’s room and located both items in the resident’s closet; therefore, nothing was missing, and there was no need to document or report an incident.

The Department reviewed R1’s Safeguard for Personal Property form dated April 4, 2023. Staff S1–S4 reiterated that if any personal belongings are reported missing, they will conduct a search and replace items if necessary. All four staff members denied the allegation.

LPA Bunker also interviewed residents R2–R6. All five residents (5 out of 6) stated that staff safeguard their personal belongings and reported that nothing has gone missing. 5 out of 5 residents shared that staff are always available to assist and ensure their personal items are accounted for. R2–R6 denied the allegation.

Allegation: Staff did not give a resident water.

LPA interviewed staff members S1-S4 (S1–S4). All four staff members (4 out of 4) stated that facility staff provide residents with plenty of water to drink and that each resident has a pitcher of water in their room. S1 and S2 stated that the resident was not hospitalized for dehydration or lack of water but was hospitalized for a urinary tract infection (UTI). S1-S4 denied the allegation. LPA interviewed residents #2-6 (R2–R6). All five residents (R2-R6) stated that they receive plenty of water to drink and have a pitcher of water in their rooms. R2–R6 denied the allegation. See continued LIC9099-C page 3.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20250707125514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HACIENDA GRANDE SENIOR ASSISTED LIVING	FACILITY NUMBER: 198205024
	VISIT DATE: 04/15/2026

NARRATIVE

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Continued LIC9099-C page 3.

Allegation: Staff did not prevent a resident from eloping from the facility.
LPA interviewed staff members S1-4 (S1–S4). All four staff members (4 out of 4) stated that the facility ensures adequate care and supervision to prevent residents from eloping. Staff stated they self-reported the incidents on February 10, 2024, and February 16, 2025, prior to the complaint. S1-S2 stated R1 briefly left the facility. In both cases, staff immediately located R1 and returned the resident to the facility within a short time.
S1 and S2 stated that the incidents were reported to the Long Beach Police Department; however, no police reports were taken. Staff explained that routine rounds are conducted every two hours. When R1 was discovered missing, staff immediately initiated a search and located the resident a short time later on the same day.
S1 and S2 stated that R1 was not considered an elopement risk and that there was no documentation in the resident’s file indicating otherwise. S1-S2 stated that caregivers noticed R1 was not in the room during their rounds. While the caregiver searched the premises, the front desk contacted 911. Staff reported that the resident exited through the front entrance in a wheelchair and was located promptly.
All four staff members (4 out of 4) also confirmed that residents are closely monitored and that the facility is not a locked facility. 4 out of 4 staff members stated that they are trained and receive initial and ongoing training on elopement policies and procedures. The Department reviewed the facility’s In-Service Training records dated 09/24/2024, 09/26/2024, 11/01/2024, 11/11/2024, 02/20/2025, and 08/18/2025.
S1 and S2 stated that on March 2, 2025, R1 was transferred to a higher-level care facility. They confirmed that all incidents were self-reported to the appropriate agencies, responsible parties, family members, and R1’s physician in a timely manner. According to staff, 4 out of 4 staff members stated that the facility followed Title 22 regulations and implemented necessary precautions to ensure resident safety at all times.
4 out of 4 staff members denied the allegation that staff did not prevent a resident from eloping from the facility.
Residents #2–#6 (R2–R6) stated that staff provide adequate care and supervision. 5 out of 6 residents reported that staff are always available to assist and consistently check on residents throughout the day and night. 5 out of 6 residents stated that they did not witness any resident eloping from the facility. R2–R6 also reported that their daily needs are being met and that they are happy living at the facility, expressing no problems or concerns. See continued LIC9099-C page 4

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250707125514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HACIENDA GRANDE SENIOR ASSISTED LIVING	FACILITY NUMBER: 198205024
	VISIT DATE: 04/15/2026

NARRATIVE

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Continued LIC9099-C page 4.

Allegation: Staff force residents to go to bed at an unreasonable time.
LPA interviewed staff members #1-4 (S1–S4). All four staff (4 out of 4) stated that residents are not forced to go to bed at an unreasonable time. 4 out of 4 staff members stated that most residents typically go to sleep around 7:00 p.m. or 8:00 p.m., after visiting hours. S1–S4 noted that R1’s responsible party often visits the facility at 8:00 p.m., when the resident is already asleep, and wakes the resident up. Staff stated that residents are not forced to go to bed at 5:30 p.m. S1-S4 denied the allegation.

LPA interviewed residents #2 -6 (R2–R6). All five residents stated that staff do not force residents to go to bed at an unreasonable time. 5 out of 6 residents stated they can go to bed whenever they choose. R2–R6 denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to the Administrator Lorenzona Medina.

No deficiencies were cited.

An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2026

LIC9099 (FAS) - (06/04)

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