Hacienda Grande Senior Assisted Living

Type of visit: Required - 1 Year

On 07/23/26 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual required visit using the CARE Inspection Tool. California Department of Social Services (CDSS) met with Lorenzona Medina - Administrator as the purpose of the visit was explained.The facility is licensed to serve 60 ambulatory and 60 non-ambulatory residents ages 60 and above. The facility has an approved hospice waiver for 10 residents. Annual fees are current and liability insurance is valid through 04/09/27. The facility is two-story commercial building consists of (60) resident bedrooms, (60) resident bathrooms, (6) common bathrooms, dining room, commercial kitchen, med-room, library, washer and dryer/storage area, a shaded sitting area, and administrative offices. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Toxins and knifes were stored and inaccessible to residents. Four (4) Resident bedrooms were checked; mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature was measured between 133.3 - 139.6°F (degrees Fahrenheit) which is outside of title 22 regulation. Please see LIC809-D. Exits and walkways are free of debris/hazards, there are no weapons nor bodies of water on the premises. LPA’s conducted a records review of 4 staff records, 4 resident records, and 4 medication reviews. Medications were centrally stored and properly locked, first aid kit was checked, fully stocked, and located in the medication room. Report continues, please see LIC809-C. The last disaster drill was conducted on 05/05/26, fire extinguishers fully charged, carbon monoxide and smoke detectors are operational. LBFD conducted a yearly fire inspection, last conducted on 01/27/26, facility is in compliance. There has been one deficiency cited during today's visit. Please see LIC809-D. An exit interview was held with Lorenzona Medina - Administrator, and a copy of facilities' appeal rights, one deficiency and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 23, 2026

Allegation investigated: Staff did not meet the resident's diapering care needs in a timely manner. Staff did not clean the resident's room in a timely manner. Residents are not provided meals that consist of an appropriate variety of foods.

On 05/07/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Adminisrator Lorenzona Medina (staff #1 S1) as the purpose of today’s visit was explained. The investigation consisted of the following: On 05/07/26 LPA Villegas obtained copies of the staff and resident rosters, facility menus for April 2026-May 2026, housekeeping schedule, and a list of incontinence care residents. On 05/07/26 LPA also obtained copies of the following documents for Resident #1-3 (R1-R3) Emergency ID forms, pre-appraisals, admission agreements, Physicians reports, needs and service plan dated: On 05/07/26 from 10:00 am- 11:30am LPA conducted Interviews with R1-R7, and from 11:30am-12pm LPA observed lunch service. On 05/07/26 from 1pm- 2pm LPA conducted interviews with staff #1-5 (S1-S5). On 05/07/26 LPA conducted a review od documents obtained. The investigation revealed the following: Unsubstantiated Allegation: Staff did not meet the resident's diapering care needs in a timely manner. It is alleged that facility staff are refusing to change residents diapers as residents can wait up to 4 hours for assistance. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 2 of the 7 residents interviewed denied the allegation above and reported staff have not refused to assist with incontinence care. 5 of the 7 residents interviewed reported that they do not require assistance with incontinence care as they can do it themselves. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 4 of the 5 staff interviewed denied the allegation above and reported that residents are provided with incontinence care assistance 2-3 times per shift or as needed. Additionally staff report that rounds/checks are conducted every 2 hours. 1 of the 5 staff interviewed reported having no knowledge of the allegation above as they do not provide direct care to residents. On 05/07/26 LPA conducted a review on documents obtained for R1. Per physicians report dated: 02/27/26, R1 requires diapers and needs assistance with toileting needs. Per R1's appraisal dated: 03/06/25 R1 requires assistance with continence, bowel, and bladder control. Per R1's individual service plan dated: 03/11/26 R1 is occasionally incontinent to both bladder and bowel but usually declines wearing pull ups. Allegation: Staff did not clean the resident's room in a timely manner. it is alleged that facility staff complain about the incontinence smell and do not to assist. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 5 out of the 7 residents interviewed denied the allegation above and reported that their bedrooms are cleaned daily. 1 of the 7 residents interviewed reported being unaware of how often their bedroom is cleaned, 1 of the 7 residents interviewed reported that their bedroom is cleaned once a week. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 4 of the 5 staff interviewed denied the allegation above and reported that resident bedrooms are cleaned every day, 1 of the 5 staff interviewed added that 5 bedrooms are deep cleaned daily. 1 of the 5 staff interviewed reported having no knowledge of the allegation above as they do not provide direct care to residents. On 05/07/26 LPA conducted a review of housekeeping schedule, per schedule there are 3-4 staff each day from 6am-4pm who oversee facility cleaning which includes resident bedrooms. Allegation: Residents are not provided meals that consist of an appropriate variety of foods. It is alleged that facility is mostly serving Filipino foods which is causing resident in care to have diarrhea often. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 6 out of the 7 residents interviewed denied the allegation above and reported that the meals provided are different everyday. 6 of the 7 residents interviewed reported that they have not gotten sick from the food they are served. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 5 of the 5 staff interviewed denied the allegation above and reported that the food served is different every day. On 05/07/26 LPA conducted a review of facility menus dated: 03/30/26- 05/10/26, LPA observed that meals are rotated and are different every day. On 05/07/26 LPA observed lunch service, LPA observed meals served to match the meal listed on the menu. Furthermore LPA observed R1 walk into the dinning room and opted out of lunch service. 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 allegation is unsubstantiated. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 7, 2026 · control 11-AS-20260427155940

Allegation investigated: Staff did not meet the resident's diapering care needs in a timely manner. Staff did not clean the resident's room in a timely manner. Residents are not provided meals that consist of an appropriate variety of foods.

On 05/07/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Adminisrator Lorenzona Medina (staff #1 S1) as the purpose of today’s visit was explained. The investigation consisted of the following: On 05/07/26 LPA Villegas obtained copies of the staff and resident rosters, facility menus for April 2026-May 2026, housekeeping schedule, and a list of incontinence care residents. On 05/07/26 LPA also obtained copies of the following documents for Resident #1-3 (R1-R3) Emergency ID forms, pre-appraisals, admission agreements, Physicians reports, needs and service plan dated: On 05/07/26 from 10:00 am- 11:30am LPA conducted Interviews with R1-R7, and from 11:30am-12pm LPA observed lunch service. On 05/07/26 from 1pm- 2pm LPA conducted interviews with staff #1-5 (S1-S5). On 05/07/26 LPA conducted a review od documents obtained. The investigation revealed the following: Unsubstantiated Allegation: Staff did not meet the resident's diapering care needs in a timely manner. It is alleged that facility staff are refusing to change residents diapers as residents can wait up to 4 hours for assistance. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 2 of the 7 residents interviewed denied the allegation above and reported staff have not refused to assist with incontinence care. 5 of the 7 residents interviewed reported that they do not require assistance with incontinence care as they can do it themselves. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 4 of the 5 staff interviewed denied the allegation above and reported that residents are provided with incontinence care assistance 2-3 times per shift or as needed. Additionally staff report that rounds/checks are conducted every 2 hours. 1 of the 5 staff interviewed reported having no knowledge of the allegation above as they do not provide direct care to residents. On 05/07/26 LPA conducted a review on documents obtained for R1. Per physicians report dated: 02/27/26, R1 requires diapers and needs assistance with toileting needs. Per R1's appraisal dated: 03/06/25 R1 requires assistance with continence, bowel, and bladder control. Per R1's individual service plan dated: 03/11/26 R1 is occasionally incontinent to both bladder and bowel but usually declines wearing pull ups. Allegation: Staff did not clean the resident's room in a timely manner. it is alleged that facility staff complain about the incontinence smell and do not to assist. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 5 out of the 7 residents interviewed denied the allegation above and reported that their bedrooms are cleaned daily. 1 of the 7 residents interviewed reported being unaware of how often their bedroom is cleaned, 1 of the 7 residents interviewed reported that their bedroom is cleaned once a week. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 4 of the 5 staff interviewed denied the allegation above and reported that resident bedrooms are cleaned every day, 1 of the 5 staff interviewed added that 5 bedrooms are deep cleaned daily. 1 of the 5 staff interviewed reported having no knowledge of the allegation above as they do not provide direct care to residents. On 05/07/26 LPA conducted a review of housekeeping schedule, per schedule there are 3-4 staff each day from 6am-4pm who oversee facility cleaning which includes resident bedrooms. Allegation: Residents are not provided meals that consist of an appropriate variety of foods. It is alleged that facility is mostly serving Filipino foods which is causing resident in care to have diarrhea often. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 6 out of the 7 residents interviewed denied the allegation above and reported that the meals provided are different everyday. 6 of the 7 residents interviewed reported that they have not gotten sick from the food they are served. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 5 of the 5 staff interviewed denied the allegation above and reported that the food served is different every day. On 05/07/26 LPA conducted a review of facility menus dated: 03/30/26- 05/10/26, LPA observed that meals are rotated and are different every day. On 05/07/26 LPA observed lunch service, LPA observed meals served to match the meal listed on the menu. Furthermore LPA observed R1 walk into the dinning room and opted out of lunch service. 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 allegation is unsubstantiated. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 7, 2026 · control 11-AS-20260427155940

Allegation investigated: 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.

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 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. 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 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.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 11-AS-20250707125514

Allegation investigated: Staff handled resident in a rough manner. Resident sustained an unexplained injury while in care. Staff not allowing a resident to use the restroom. Staff are not allowing a resident to use a medical device. Staff did not ensure resident was cleaned during diaper changes. Staff did not serve an adequate amount of food to residents in care. Staff did not prevent the facility from being unkempt. Staff illegally evicted a resident in care. Staff left residents in a soiled diaper for a long period of time.

The purpose of the visit is to provide additional information not included in the report dated January 21, 2026; the findings remain the same. On April 15, 2026, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial 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 21,2026, the following documents were reviewed 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, and 11/11/1024). See continued LIC9099-C page 2. Unsubstantiated Continued LIC9099-C page 2. Unusual Incident/Injury Report (dated 02/10/2024 & 02/16/2024), 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 12/19/2025, between 10:00 a.m. and 3:00 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 #1: Staff handled the resident in a rough manner. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that facility staff did not handle any resident in a rough manner. 4 out of 4 staff members stated that no staff member caused a resident to cry or slam a resident’s wheelchair to the ground while the resident was seated in it. S1–S4 denied the allegation. LPA interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that the staff has never handled any resident roughly. 5 out of 6 residents reported that staff provide a safe and comfortable environment and would never harm a resident. 5 out of 5 residents reported feeling safe in the facility and stated that staff cares about their well-being. 5 out of 6 residents reported being happy with the staff and the care they are receiving, and they had no problems or concerns. R2–R6 denied the allegation. LPA observed staff interactions with residents during the visit and noted that staff were respectful, gentle, and attentive to residents’ needs. No evidence was found to support the allegation. Allegation #2: Resident sustained an unexplained injury while in care. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that no resident sustained an unexplained injury while in care. Staff explained that any injuries are documented immediately, and incident reports are completed and submitted to the Department as required. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they did not witness any resident sustaining an unexplained injury while in care. Residents reported feeling safe and confirmed that staff respond promptly to any concerns. R2–R6 denied the allegation. See continued LIC 9099-C page 3. Continued LIC9099-C page 3 LPA reviewed the facility’s incident and injury logs for the past six months and found no documentation of unexplained injuries regarding the resident. During the visit, LPA observed residents in care and noted no visible injuries or signs of neglect. No evidence was found to support the allegation. Allegation #3: Staff not allowing a resident to use the restroom. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are always allowed to use the restroom as needed and that staff do not restrict access. Staff explained that residents are encouraged to use the restroom independently, and assistance is provided only when requested or necessary. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that they are free to use the restroom whenever they need to and stated that they are independent and do not require staff assistance for restroom use. R2–R6 denied the allegation. LPA observed residents moving freely throughout the facility during the visit, including access to restrooms without staff interference. No evidence was observed to support the allegation. Allegation #4: Staff are not allowing a resident to use a medical device. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are allowed to use their prescribed medical devices according to their physician’s orders. 4 out of 4 staff members explained that they assist residents with medical devices when needed and ensure proper usage for safety and compliance. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they are allowed to use their medical devices without restriction and reported no issues or interference from staff. R2–R6 denied the allegation. LPA observed residents during the visit and noted that medical devices were present and in use as appropriate. LPA reviewed residents’ medical records and confirmed that physician orders for medical devices were documented and followed. No evidence was found to support the allegation. See continued LIC9099-C page 4 Continued LIC9099-C page 4. Allegation #5: Staff did not ensure the resident was cleaned during diaper changes. LPA interviewed staff members S1–S4 (S1–S4). All four staff members (4 out of 4) stated that staff assist residents with diapering and ensure diapers are changed every two hours or as often as needed based on individual needs. 4 out of 4 staff members confirmed that proper hygiene practices are followed during diaper changes, including cleaning the resident before applying a new diaper. 4 out of 4 staff members stated that staff do not instruct residents to urinate in their diapers. 4 out of 4 staff members stated that residents are not left in soiled diapers for extended periods and do not exhibit a foul odor. S1–S4 denied the allegation. LPA also interviewed residents #2-#6 (R2–R6). 1 out of 6 resident stated that staff change their diapers regularly and that they are never left in soiled diapers or garments. R2 stated that staff cleans them appropriately during diaper changes. 4 out of 6 residents stated that they do not wear diapers and are independent in their toileting needs. Resident #1 (R1) was unavailable for an interview. Resident R1, who had been receiving incontinence care, was unavailable for an interview and is no longer residing at the facility. R2–R6 denied the allegation. During the visit, LPA observed staff performing diaper changes during the visit and noted that staff followed proper hygiene protocols, including cleaning the resident before placing a new diaper. No evidence was observed to support the allegation. Allegation #6: Staff did not serve an adequate amount of food to residents in care. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are served an adequate amount of food. Staff confirmed that residents receive three meals per day plus snacks and have access to an ample supply of both perishable and non-perishable food items. 4 out of 4 staff members explained that residents are provided with more than enough food and are allowed second servings. If a resident does not like what is being served, alternative options are available. S1-S4 denied the allegation. LPA observed residents eating lunch during the visit and verified that the facility’s food supply was sufficient. The observed meal included generous portions, and staff followed the posted menu. LPA also reviewed the facility’s food menus from May 2025 through July 2025 and confirmed compliance with meal planning requirements. See continued LIC9099-C page 5. Continued LIC9099-C page 5 LPA interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they receive three meals per day plus snacks and have plenty of food to eat. Residents stated they are satisfied with the meals provided and had no complaints about the food. R2–R6 denied the allegation. LPA inspected the kitchen and pantry areas and confirmed that the facility maintained the required two-day supply of perishable foods and seven-day supply of non-perishable foods, in accordance with Title 22 regulations. No evidence was found to support the allegation. Allegation #7: Staff did not prevent the facility from being unkempt. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that the facility is cleaned daily and maintained in good condition. 4 out of 4 staff members explained that cleaning schedules are followed consistently, including sanitizing common areas, resident rooms, and bathrooms. S1–S4 denied the allegation. During the visit, LPA observed the facility to be clean, organized, and in good repair. Floors, furniture, and bathrooms were free of dirt and clutter, and no safety hazards were noted. The facility appeared well-maintained and met Title 22 requirements for cleanliness and sanitation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that staff cleans the facility every day and confirmed that the environment is kept neat and sanitary. Residents reported no concerns regarding cleanliness. R2–R6 denied the allegation. LPA reviewed the facility’s housekeeping schedule and confirmed that daily cleaning tasks are documented and completed. No evidence was found to support the allegation. See continued LIC9099-C page 6 Continued LIC9099-C page 6 Allegation #8: Staff illegally evicted a resident in care. LPA interviewed staff members #1–4 (S1–S4). S1 and S2 stated that staff did not illegally evict the resident and confirmed that the resident never received an eviction notice. 2 out of 4 staff members explained that the resident required a higher level of care due to increased needs and was referred to a locked memory care facility for safety and supervision. S3 and S4 stated they do not handle eviction matters and had no knowledge of any illegal eviction. 4 out of 4 staff members stated that the this facility is an assisted living facility where residents are free to come and go as they please. S1 and S2 stated that no formal eviction process occurred. S1–S2 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they were not aware of any illegal eviction and stated that they themselves had not received an eviction notice. R2–R6 denied the allegation. LPA reviewed the resident’s file and observed documentation indicating that the resident’s condition had changed, requiring a higher level of care. The facility followed proper procedures by notifying the responsible party and assisting with the transition to an appropriate care setting. No evidence was found to support the allegation of an illegal eviction. Allegation #9: Staff left residents in a soiled diaper for a long period of time. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are not left in soiled diapers for extended periods. 4 out of 4 staff members explained that residents are checked and changed every two hours or more frequently as needed to maintain hygiene and comfort. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that staff do not leave residents in soiled diapers and stated that staff respond promptly when assistance is needed. R2–R6 denied the allegation. See continued LIC9099-C page 7 Continued LIC9099-C page 7. LPA observed staff providing care during the visit and noted that proper diapering procedures were followed. LPA reviewed the facility’s care logs, which documented regular diaper checks and changes in accordance with the facility’s policy and Title 22 regulations. No evidence was found to support 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-Cs was provided to Lorenzona Medina, Administrator. No deficiencies were cited during this visit. An exit interview was conducted.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 11-AS-20250707125514

Type of visit: Case Management - Other

On 04/09/26 Licensing Program Analyst (LPA) Villegas conducted a health and safety check for residents that were relocated from another facility. LPA met with Administrator as the purpose of the visit was explained. During visit LPA conducted a tour of the facility including kitchen and obtained a copy of the resident roster. LPA observed the kitchen to have (4) refrigerators, (1) walk in freezer, and (1) pantry all adequately stocked. Per Administrator the facility receives food delivery once a week. Administrator reported that no residents are on a special diet (Ex: chopped, pureed). LPA observed that additional tables and chairs have been temporarily placed in the TV for residents to have their meals, Administrator informed LPA that facility staff is working on re-arranging dinning room so that all residents can enjoy their meals in the dinning room comfortably. During tour of the facility LPA checked that relocated residents were doing well and that residents have the appropriate furniture to accommodate them comfortably. Administrator reported that (2) of the relocated residents are currently at the hospital and that an unusual incident report was sent to CCLD. LPA requested an update on relocated residents records. Per Administrator, relocated residents have met with Physician and all have obtained order for lab work. Additionally, Administrator reports that records are coming along, LPA reminded Administrator that Physicians reports with TB test results, and a care plan must be available for all residents. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

Allegation investigated: 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.

On January 26, 2026, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial 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, and 11/11/1024). See continued LIC9099-C page 2. Unsubstantiated 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 interviewed staff members S #1–S4 (S1-S4). All four staff members (4 out of 4) stated that facility staff safeguard residents’ personal belongings. They explained that Resident R1’s laundry is handled by the responsible party, not by facility staff. S1–S4 further stated that if any personal belongings are missing, staff will search for the items or replace what is missing. S1-S4 denied the allegation. LPA interviewed Residents #2–#6 (R2–R6), who stated that staff safeguard their personal belongings and nothing has gone missing. 5 out of 6 residents reported that staff are always available to assist and make sure they are not missing any of their personal items. R2-R2 denied the allegation. Allegation: Staff did not give a resident water. LPA interviewed staff members #1-4 (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. Continued LIC9099-C page 3. Allegation: Staff did not prevent a resident from eloping from the facility. LPA interviewed staff members #1-4 (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 16, 2024, and February 10, 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, and when R1 was discovered missing, staff initiated a search immediately and successfully located the resident a short time later, the same day. 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 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.the state’s words, verbatim · CDSS document, Jan 26, 2026 · control 11-AS-20250707125514

Allegation investigated: Staff handled resident in a rough manner. Resident sustained an unexplained injury while in care. Staff not allowing a resident to use the restroom. Staff are not allowing a resident to use a medical device. Staff did not ensure resident was cleaned during diaper changes. Staff did not serve an adequate amount of food to residents in care. Staff did not prevent the facility from being unkempt. Staff illegally evicted a resident in care. Staff left residents in a soiled diaper for a long period of time.

On January 21, 2026, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial 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 21,2026, the following documents were reviewed 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, and 11/11/1024). See continued LIC9099-C page 2. Unsubstantiated Continued LIC9099-C page 4. Allegation #5: Staff did not ensure resident was cleaned during diaper changes. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that staff assist residents with diapering and ensure diapers are changed every two hours or as often as needed based on individual needs. 4 out of 4 staff members confirmed that proper hygiene practices are followed during diaper changes, including cleaning the resident before applying a new diaper. 4 out of 4 staff members stated that staff do not instruct residents to urinate in their diapers. 4 out of 4 staff members stated that residents are not left in soiled diapers for extended periods and do not exhibit a foul odor. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). One resident (1 out of 6) stated that staff change their diapers regularly and that they are never left in soiled diapers. 1 out of 6 residents stated that staff cleans them appropriately during diaper changes. 4 out of 6 residents stated that they do not wear diapers and are independent in their toileting needs. R2 denied the allegation. During the visit, LPA observed staff performing diaper changes during the visit and noted that staff followed proper hygiene protocols, including cleaning the resident before placing a new diaper. No evidence was observed to support the allegation. Allegation #6: Staff did not serve an adequate amount of food to residents in care. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are served an adequate amount of food. Staff confirmed that residents receive three meals per day plus snacks and have access to an ample supply of both perishable and non-perishable food items. 4 out of 4 staff members explained that residents are provided with more than enough food and are allowed second servings. If a resident does not like what is being served, alternative options are available. S1-S4 denied the allegation. LPA observed residents eating lunch during the visit and verified that the facility’s food supply was sufficient. The observed meal included generous portions, and staff followed the posted menu. LPA also reviewed the facility’s food menus from May 2025 through July 2025 and confirmed compliance with meal planning requirements. See continued LIC9099-C page 5. Continued LIC9099-C page 3 LPA reviewed the facility’s incident and injury logs for the past six months and found no documentation of unexplained injuries regarding the resident. During the visit, LPA observed residents in care and noted no visible injuries or signs of neglect. No evidence was found to support the allegation. Allegation #3: Staff not allowing a resident to use the restroom. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are always allowed to use the restroom as needed and that staff do not restrict access. Staff explained that residents are encouraged to use the restroom independently, and assistance is provided only when requested or necessary. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that they are free to use the restroom whenever they need to and stated that they are independent and do not require staff assistance for restroom use. R2–R6 denied the allegation. LPA observed residents moving freely throughout the facility during the visit, including access to restrooms without staff interference. No evidence was observed to support the allegation. Allegation #4: Staff are not allowing a resident to use a medical device. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are allowed to use their prescribed medical devices according to their physician’s orders. 4 out of 4 staff members explained that they assist residents with medical devices when needed and ensure proper usage for safety and compliance. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they are allowed to use their medical devices without restriction and reported no issues or interference from staff. R2–R6 denied the allegation. LPA observed residents during the visit and noted that medical devices were present and in use as appropriate. LPA reviewed residents’ medical records and confirmed that physician orders for medical devices were documented and followed. No evidence was found to support the allegation. See continued LIC9099-C page 4 Continued LIC9099-C page 2. Unusual Incident/Injury Report (dated 02/10/2024 & 02/16/2024), 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 12/19/2025, between 10:00 a.m. and 3:00 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 #1: Staff handled the resident in a rough manner. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that facility staff did not handle any resident in a rough manner. 4 out of 4 staff members stated that no staff member caused a resident to cry or slam a resident’s wheelchair to the ground while the resident was seated in it. S1–S4 denied the allegation. LPA interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that the staff has never handled any resident roughly. 5 out of 6 residents reported that staff provide a safe and comfortable environment and would never harm a resident. 5 out of 5 residents reported feeling safe in the facility and stated that staff cares about their well-being. 5 out of 6 residents reported being happy with the staff and the care they are receiving, and they had no problems or concerns. R2–R6 denied the allegation. LPA observed staff interactions with residents during the visit and noted that staff were respectful, gentle, and attentive to residents’ needs. No evidence was found to support the allegation. Allegation #2: Resident sustained an unexplained injury while in care. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that no resident sustained an unexplained injury while in care. Staff explained that any injuries are documented immediately, and incident reports are completed and submitted to the Department as required. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they did not witness any resident sustaining an unexplained injury while in care. Residents reported feeling safe and confirmed that staff respond promptly to any concerns. R2–R6 denied the allegation. See continued LIC 9099-C page 3. Continued LIC9099-C page 5 LPA interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they receive three meals per day plus snacks and have plenty of food to eat. Residents stated they are satisfied with the meals provided and had no complaints about the food. R2–R6 denied the allegation. LPA inspected the kitchen and pantry areas and confirmed that the facility maintained the required two-day supply of perishable foods and seven-day supply of non-perishable foods, in accordance with Title 22 regulations. No evidence was found to support the allegation. Allegation #7: Staff did not prevent the facility from being unkempt. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that the facility is cleaned daily and maintained in good condition. 4 out of 4 staff members explained that cleaning schedules are followed consistently, including sanitizing common areas, resident rooms, and bathrooms. S1–S4 denied the allegation. During the visit, LPA observed the facility to be clean, organized, and in good repair. Floors, furniture, and bathrooms were free of dirt and clutter, and no safety hazards were noted. The facility appeared well-maintained and met Title 22 requirements for cleanliness and sanitation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that staff cleans the facility every day and confirmed that the environment is kept neat and sanitary. Residents reported no concerns regarding cleanliness. R2–R6 denied the allegation. LPA reviewed the facility’s housekeeping schedule and confirmed that daily cleaning tasks are documented and completed. No evidence was found to support the allegation. See continued LIC9099-C page 6 Continued LIC9099-C page 6 Allegation #8: Staff illegally evicted a resident in care. LPA interviewed staff members #1–4 (S1–S4). S1 and S2 stated that staff did not illegally evict the resident and confirmed that the resident never received an eviction notice. 2 out of 4 staff members explained that the resident required a higher level of care due to increased needs and was referred to a locked memory care facility for safety and supervision. S3 and S4 stated they do not handle eviction matters and had no knowledge of any illegal eviction. 4 out of 4 staff members stated that the this facility is an assisted living facility where residents are free to come and go as they please. S1 and S2 stated that no formal eviction process occurred. S1–S2 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated they were not aware of any illegal eviction and stated that they themselves had not received an eviction notice. R2–R6 denied the allegation. LPA reviewed the resident’s file and observed documentation indicating that the resident’s condition had changed, requiring a higher level of care. The facility followed proper procedures by notifying the responsible party and assisting with the transition to an appropriate care setting. No evidence was found to support the allegation of an illegal eviction. Allegation #9: Staff left residents in a soiled diaper for a long period of time. LPA interviewed staff members #1–4 (S1–S4). All four staff members (4 out of 4) stated that residents are not left in soiled diapers for extended periods. 4 out of 4 staff members explained that residents are checked and changed every two hours or more frequently as needed to maintain hygiene and comfort. S1–S4 denied the allegation. LPA also interviewed residents #2–6 (R2–R6). All five residents (5 out of 6) stated that staff do not leave residents in soiled diapers and stated that staff respond promptly when assistance is needed. R2–R6 denied the allegation. See continued LIC9099-C page 7 Continued LIC9099-C page 7 LPA observed staff providing care during the visit and noted that proper diapering procedures were followed. LPA reviewed the facility’s care logs, which documented regular diaper checks and changes in accordance with the facility’s policy and Title 22 regulations. No evidence was found to support 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-Cs was provided to Lorenzona Medina, Administrator. No deficiencies were cited during this visit. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jan 21, 2026 · control 11-AS-20250707125514

Allegation investigated: Staff speak to resident inappropriately.

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 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.the state’s words, verbatim · CDSS document, Aug 27, 2025 · control 11-AS-20250820150324

Type of visit: Office

On August 26, 2025, at 1:30 PM, an office meeting was held to discuss Complaint 11-AS-20210226154939. Present at the meeting were Janae Hammond, Licensing Program Manager (LPM); Lizeth Villegas Licensing Program Analyst (LPA), Rodrigo Ramos Licensee, Elvie Medina Lorenzona Administrator, Shalani Ramos Quality assurance, and Luwana Klarstrom Compliance. During the meeting, the LPM reviewed the details of the complaint. On April 8, 2022, the Department substantiated an allegation of neglect and lack of care and supervision, which facility staff retained a resident with a prohibited health condition that needed a higher level of care due to pressure injuries. At the time the findings were delivered on April 8, 2022, the Department indicated that an enhanced civil penalty determination was pending, pursuant to Health and Safety Code Section 1569.49(e), relating to Serious Bodily Injury. The Department is reviewing the complaint for enhanced civil penalty for serious bodily injury pursuant to H&S 1569.49(e). The total amount for the civil penalty totals $10,000 for Serious bodily injury. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 26, 2025

Allegation investigated: Staff did not prevent resident from engaging in inappropriate interactions with another resident in care.

*This report supersedes the investigation report dated 07/03/25. A subsequent visit was conducted on 08/07/2025 to clarify findings in the report. Although this report supersedes the previous report, the complaint investigation findings remain the same*. The department was greeted by Rodrigo Ramos, Licensee, and the purpose of the visit was explained. On 7/3/25, at 09:30am, the department conducted an initial complaint visit to the facility and was greeted by Lorenzona Elvie Medina, Administrator. Later joined by Rodrigo Ramos, Licensee. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff/residents, and deliver findings for the allegation mentioned above. The investigation consisted of the following: The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S5), and residents (R1-R7) from 9:30am-12:00pm. The department received the following documents: Resident Roster (Dated: No Date), Staff Roster (Dated: 11/14/2025), ID Emergency Information (Dated: 10/29/2018, 01/21/2020, 2/28/2021), Physicians Report (Dated: 12/13/2024,12/20/2024, 03/20/2025)... Report Continued on LIC909-C Unsubstantiated Resident Appraisal Information (Dated:04/07/2025, 01/23/2024, 03/12/2024, 03/20/2025), Preplacement Appraisal (Dated: 03/12/2024) and Medication List (Dated: 07/01/2025-07/31/2025), from the facility. The investigation revealed the following: Allegation- Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. The details of the complaint alleged that a resident in the facility exposed themselves to another resident (R1) in care. On 7/3/25, from 9:30am-12:00pm, the department interviewed staff (S1-S5) and residents (R1-R7) regarding the allegation. All staff (S1-S5) denied the allegation that Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. Staff stated that they did not witness any inappropriate interactions between residents that was sexual in nature. They further state that no other resident to their knowledge has been observed exposing themselves to other residents or staff. They state that a resident (R1) in the facility has been known to fabricate and have delusions that people were doing things to them which turned out not to be true, once investigated. Staff stated that (R1) has a mental condition that brings about paranoid delusions, agitated behavior, and psychosis. The department interviewed residents (R1-R7) about the allegation and 6 of 7 residents that were interviewed, denied any knowledge of inappropriate behaviors from residents that were sexual in nature. They stated that they have not witnessed or were aware of anyone exposing themselves in the facility. While resident (R1) declined to participate in the interview. The department reviewed the Physicians Report (Dated: 03/20/2025), Resident Appraisal (Dated: 03/20/2025), Medication List (Dated: 07/01/2025-07/31/2025), and Preplacement Appraisal (Dated: 03/12/2024) and did not observe any reports that would support the allegation in being substantiated. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. 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 because of neglect, therefore the allegation is Unsubstantiated. No citations were issued. An exit interview was conducted with Rodrigo Ramos, Licensee, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, Aug 7, 2025 · control 11-AS-20250624140329

Allegation investigated: Staff did not prevent resident from engaging in inappropriate interactions with another resident in care.

On 7/3/25, at 09:30am, the department conducted an initial complaint visit to the facility and was greeted by Lorenzona Elvie Medina, Administrator. Later joined by Rodrigo Ramos, Licensee. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff/residents, and deliver findings for the allegation mentioned above. The investigation consisted of the following: The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S5), and residents (R1-R7) from 9:30am-12:00pm. The department received the following documents: Resident Roster (Dated: No Date), Staff Roster (Dated: 11/14/2025), ID Emergency Information (Dated: 10/29/2018, 01/21/2020, 2/28/2021), Physicians Report (Dated: 12/13/2024,12/20/2024, 03/20/2025), Resident Appraisal Information (Dated:04/07/2025, 01/23/2024, 03/12/2024, 03/20/2025), Preplacement Appraisal (Dated: 03/12/2024) and Medication List (Dated: 07/01/2025-07/31/2025), from the facility. Report Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation- Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. The details of the complaint alleged that a resident in the facility exposed themselves to another resident (R1) in care. On 7/3/25, from 9:30am-12:00pm, the department interviewed staff (S1-S5) and residents (R1-R7) regarding the allegation. All staff (S1-S5) denied the allegation that Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. Staff stated that they did not witness any inappropriate interactions between residents that was sexual in nature. They further state that no other resident to their knowledge has been observed exposing themselves to other residents or staff. They state that a resident (R1) in the facility has been known to fabricate and have delusions that people were doing things to them which turned out not to be true, once investigated. Staff stated that (R1) has a mental condition that brings about paranoid delusions, agitated behavior, and psychosis. The department interviewed residents (R1-R7) about the allegation and 6 of 7 residents that were interviewed, denied any knowledge of inappropriate behaviors from residents that were sexual in nature. They stated that they have not witnessed or were aware of anyone exposing themselves in the facility. While resident (R1) declined to participate in the interview. The department reviewed the Physicians Report (Dated: 03/20/2025), Resident Appraisal (Dated: 03/20/2025), Medication List (Dated: 07/01/2025-07/31/2025), and Preplacement Appraisal (Dated: 03/12/2024) for (R1) and observed that the resident has a medical history of schizoaffective behavior, psychosis, and paranoia. The department also observed that the resident is taking aripiprazole and lithium medication, which is used to treat psychosis and bipolar disorder. Symptoms of psychosis include delusions, hallucinations, and agitation. During an episode of psychosis, a person’s thoughts and perceptions are disrupted and they may have difficulty recognizing what is real and what is not, according to the National Institute of Mental Health website www.nimh.nih.gov . Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not prevent resident from engaging in inappropriate interactions with another resident in care. 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 because of neglect, therefore the allegation is Unsubstantiated. No citations were issued. An exit interview was conducted with Lorenzona Elvie Medina, Administrator, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, Jul 3, 2025 · control 11-AS-20250624140329

Type of visit: Required - 1 Year

On 05/28/25 Licensing Program Analyst’s (LPA’s) Villegas and Gibbs conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Licensee Rodrigo Ramos, and Acting Administrator Shalani Ramos as the purpose of the visit was explained.The facility is licensed to serve 60 ambulatory and 60 non-ambulatory residents ages 60 and above. The facility has an approved hospice waiver for 10 residents. An active liability insurance was observed to have an expiration date of 04/09/26. Acting Administrator was provided with pin and information regarding the annual fee of $1,982 due by 06/26/25. The facility is two-story commercial building consists of (60) resident bedrooms, (60) resident bathrooms, (6) common bathrooms, dining room, commercial kitchen, med room, library, washer and dryer/ storage area, a shaded sitting area, and administrative offices. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Toxins and knifes were stored and inaccessible to residents. (5) Resident bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. Exits and walkways are free of debris/hazards, there are no weapons nor bodies of water on the premises. LPA’s conducted a records review of 5 staff records, 5 resident records, and 5 medication reviews. Medications were centrally stored and properly locked, first aid kit was checked, fully stocked, and located in the medication room. The last disaster drill was conducted on 02/28/25, fire extinguisher fully charged, carbon monoxide and smoke detectors are operational. LBFD conducted a fire inspection on 04/16/24, facility is in compliance. Deficiencies cited on 809D page. Exit interview conducted, appeal rights explained, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 28, 2025

Allegation investigated: Staff neglect resulted in a resident being hospitalized . Client did not receive medication as prescribed.

On 01/09/25 Licensing Program Analysts (LPAs) Villegas and Day conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Administrator (A1) Lorenzona Medina as the purpose of today’s visit was explained. The investigation consisted of the following: On 02/07/24 LPA obtained a copy of the staff and residents rosters, conducted a tour, there were no immediate health and safety concerns, conducted a medication review, conducted interview with staff 1 (S1), and obtained copies of the following: Resident #1 (R1) complete file, incident report dated 01/29/24, order summary report dated 01/04/24, communication log for 01/04/24 and 01/28/24, and medication technician communication log dated 01/25/24 and 01/29/24.On 01/09/25 LPAs obtained a copy of the resident and staff rosters, on 01/09/25 between 10am- 10:45 am LPAs conducted interviews with residents #2-6 (R2-R6), and between 11am- 11:15am LPAs conducted interview with Administrator (A1). Unsubstantiated The investigation revealed the following: Allegation: Staff neglect resulted in a resident being hospitalized. It is being alleged that resident did not receive high blood pressure medication which resulted resident being hospitalized with kidney failure. On 02/07/24 LPA Villegas interviewed staff 1 (S1) regarding the allegation above, S1 denied the allegation above and reported that on 01/24/24 the VA sent residents cycle meds to the SNF where resident was previously receiving treatment. Per S1, VA Dr. and Dr. reported medications would be re-sent to Hacienda Grande Senior Living. On 07/30/24 LPA Villegas conducted a review of R1’s medical records from St. Mary medical center in Long Beach from dates 1/29/2024 through 2/08/2024, per medical records resident was admitted on 01/29/24 diagnosis of visit being shortness of breath, acute renal injury, and hyperkalemia. On 02/07/24 LPA Villegas conducted a review of R1’s physicians report dated 12/18/23 and preplacement appraisal dated 12/18/23 which revealed R1 was diagnosed with acute kidney failure upon admission to the Hacienda Grande Senior Living. On 11/24/24 the department conducted a review of R1’s medical records from St. Mary medical center in Long Beach from dates 1/29/2024 through 2/08/2024 which upon review it was determined it would be difficult to prove that missing any medications for a few days would have contributed to kidney failure since R1 already was at CKD stage 5, which is kidney failure (or close to failing) requiring dialysis or kidney transplant for survival. On 01/09/25 between 10am- 10:45 am LPAs conducted interviews with R2-R6, 5 of 5 residents interviewed denied the allegation above. On 01/09/25 between 11am- 11:15am LPAs conducted interview A1 regarding the allegation above, A1 denied the allegation above and reported R1 was admitted to Hacienda Grande Senior Assisted Living with diagnosis of Kidney failure. Allegation: Staff mishandled a resident's medication while in care. It is being alleged that R1 was without medication for just a few days. On 02/07/24 LPA Villegas interviewed S1 regarding the allegation above, S1 confirmed the allegation above and reported that 3 days’ worth of medication were found in residents’ bedroom on 01/25/24. Per S1 R1 was reminded of the importance of medication compliance, per S1 moving forward staff will watch R1 take medications. On 02/07/24 LPA Villegas conducted a review and confirmed that the facility sent CCLD an incident report dated 01/25/24 reporting that R1 did not take AM nor PM medications on 01/22/24, 01/23/24, and on 01/24/24. On 12/30/24 LPA Villegas conducted a review of R1’s Physicians report dated 12/18/23 which indicates R1 can administer own prescribed meds, able to administer own PRN’s and R1 is able to store own meds. On 12/30/24 LPA Villegas conducted a review of PM shift med-tech communication log dated 01/24/24, per S1 01/25/24 3 days’ worth of bedtime medications found, when questions R1 reported R1 forgot to take the medication. On 02/07/24 LPA Villegas conducted a conducted a medication review and did not observe any discrepancies. On 01/09/25 between 10am- 10:45 am LPAs conducted interviews with R2-R6, 3 of 5 residents interviewed denied the allegation above. 2 of 5 residents interviewed reported going without medications for 3 days, 2 of 5 residents reported obtaining medications after making appointment and having prescription sent to the pharmacy. On 01/09/25 between 11am- 11:15am LPAs conducted interview with A1 regarding the allegation above, A1 denied the allegation and reported staff administered R1 medications as prescribed, however staff did not watch R1 take medications as it is documented on R1’s Physicians report dated 12/18/23 that R1 can take own meds. A1 continued to report that on 01/25/24 (3) days’ worth of medication were found in residents’ bedroom by staff, which was reported to CCLD. 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 allegation is unsubstantiated. Exit interview conducted with Administrator Lorenzona Medina, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 11-AS-20240205224822

Allegation investigated: Unlawful eviction. Facility staff open resident's mail without permission.

On 10/23/24, at 9:35am, Licensing Program Analysts (LPAs) Perry Scott and Wendy Gibbs conducted an initial complaint visit to the facility and was greeted by Lorenzona Medina (S2), Administrator, and Rodrigo Ramos (S1), Licensee. LPAs explained the purpose of this visit is to conduct interviews, gather facility files, and render findings in the complaint. The investigation consisted of the following: LPA investigated the allegations mentioned in this complaint and conducted interviews with staff (S1-S3) and residents (R1-R6). Additionally, LPA obtained the following facility documents: Resident Roster (Dated: 1/04/2024), Staff Roster (Dated: 1/10/2024), Admission Agreement (Dated: 07/25/2024), Eviction Notice (Dated: 9/11/2024) Copy of Check (Dated: 08/26/2024 & 08/30/2024) Physicians Report (Dated: 07/20/2024), ID/Emergency Information (Dated: 07/25/2024), Flex Notes (Dated: 08/14/24, 09/20/24, and10/09/24), Medication Administration Record Receipt of Meds (Dated:10/08/24), Rent Invoice (Dated: 08/01/24, 09/01/24, 10/01/24) and Email Notice (Dated: 10/09/24) from the facility. Report continued on LIC9099-C Substantiated The investigation revealed the following: Allegation #1- Unlawful eviction. The details of the complaint alleged that the licensee issued the resident (R1) an eviction notice on 9/11/2024 due to possible non-payment. On 10/23/24, from 09:35am-12:30pm, LPAs interviewed staff (S1-S3) and residents (R1-R6) regarding the allegation. 2 of 3 staff (S1- S3) denied the allegation that the facility issued an Unlawful eviction. Staff (S1-S2) stated that they did not issue a 30-day eviction notice to R1 but rather a notice that the rent was past due and that R1 had not paid any rent since R1 was admitted on 07/25/24, and if not received, then the facility would issue an eviction letter. One staff had no knowledge of an eviction notice. LPA reviewed the notice and observed that in the heading of the letter it says, “This letter shall serve as a 30 day notice to vacate room 229A because of failure to pay the services rendered by Hacienda Grande”. LPA also reviewed the rent invoices (Dated: 08/01/24, 09/01/24, 10/01/24) that shows a past due balance of rent unpaid. LPA interviewed residents R1-R6 about the allegation and 1 of 6 residents that were interviewed corroborated the allegation that the facility issued an Unlawful eviction. Resident (R1) stated that they issued an eviction letter to them on 9/11/24. 5 of 6 residents stated that they have not been issued an eviction notice. Based on interviews and records reviewed the Licensee, (S1) failed to serve R1 with an eviction notice in accordance with tittle 22 regulations. A review of the eviction notice dated 09/11/24, revealed the following items were not included in the eviction notice: The eviction notice was missing resources and referrals for R1, a statement regarding if R1 stays at the facility an unlawful detainer shall be filed. Also, a written copy of the eviction notice was not issued to Community Care Licensing (CCLD) within 5-days. The facility stated that they mailed a copy to the Monterey Park office on 09/11/24. CCLD received the eviction notice on 10/09/24. Moreover, a statement indicating the residents right to file a complaint with CCLD and the contact information for the Long-Term Care Ombudsman was missing from the eviction letter. Therefore, the above allegation Unlawful eviction, is found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) deficiencies are being cited on the attached LIC 9099D. Allegation #2- Facility staff open resident's mail without permission. The details of the complaint alleged that the facility opened the residents’ (R1) mail without consent, including the residents’ social security checks. On 10/23/24, from 09:35am-12:30pm, LPAs interviewed staff (S1-S3) and residents (R1-R6) regarding the allegation. 2 of 3 staff (S1-S3) denied the allegation that the Facility staff open resident's mail without permission. S1 stated that all mail that are checks with their name on it (Hacienda Grande) are opened and processed. And any other mail that is not addressed to Hacienda Grande and are addressed to the residents are not opened. LPA reviewed the copy of two checks and observed that R1s name was on the check above the facilities name. The name and address of the facility below R1s name is the facility that R1 is residing at, and therefore should not have been opened. Report continued on LIC9099-C LPA interviewed residents (R1-R6) about the allegation and 1 of 6 residents that were interviewed corroborated the allegation that the Facility staff open resident's mail without permission. R1 stated that the facility had no right to open R1s mail because it was not addressed to the facility but to R1 only. 5 of 6 residents stated that they have not had an issue with the facility opening their mail. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation: Facility staff open resident's mail without permission, is found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) Deficiencies are being cited on the attached LIC 9099D. Citations were issued, and plans of corrections were discussed. Note: *Citations not cleared by the due date will have a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. An exit interview was conducted with Rodrigo Ramos, Licensee, and a copy of this Complaint Investigation Report and appeal rights were provided. LPA interviewed residents (R1-R6) about the allegation and 1 of 6 residents that were interviewed corroborated the allegation that the Facility staff did not provide a safe environment for the residents. The majority of residents (5 of 6) interviewed stated that the facility does provide a safe environment and that they are happy with the care and supervision provided by the staff. Based on interviews, there is insufficient evidence to support the allegation that the Facility staff did not provide a safe environment for the residents. 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 Rodrigo Ramos, Licensee, and a copy of this Complaint Investigation Report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 11-AS-20241014150005

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d)(1)(B)(C)(D) · Plan of correction due date: Oct 30, 2024

87224(d)(1)(B)(C)(D) Eviction Procedures. (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction... (1) The notice to quit shall include the following information: (B) Resources available to assist ...Referral services...(C) A statement informing residents of their right to file a complaint with the licensing agency…(D)…the residential care facility for the elderly must file an unlawful detainer action. This requirement is not met as evidenced by: Based on interviews and records reviewed, the licensee failed to serve resident (R1) with an eviction notice in accordance with tittle 22 regulations. This poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2024

Plan of correction: R1 no longer resides in the facility. In the future, Administrator will submit an eviction notice that is in compliance with Title 22 regulations, 87224(d)(1)(B)(C)(D) Eviction Procedures. Administrator will submit a statement acknowledging understanding of Title 22 Regulations by POC due date of 10/30/24 and email it to LPA Perry Scott at perry.scott@dss.ca.gov.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1)(3) · Plan of correction due date: Oct 30, 2024

87468.1(a)(1)(3) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on a record review of the eviction notice dated 9/11/24. The licensee failed to ensure the residents’ personal rights due to the nature of and items in the eviction notice to the resident by making inappropriate statements. The licensee stated in the eviction notice that the resident knows how to ride the system, is a manipulator, and threatened to have R1 removed from a state funded program, which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 23, 2024

Plan of correction: Licensee to review Personal Rights of Residents 87468.1(a)(1)(3) and submit a statement acknowledging understanding of Title 22 Regulations by POC due date of 10/30/24 and email it to LPA Perry Scott at perry.scott@dss.ca.gov.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(15) · Plan of correction due date: Oct 30, 2024

87468.1(a)(15) Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (15) To send and receive unopened correspondence in a prompt manner. This requirement is not as evidenced by: Based on interviews, the licensee failed to ensure resident's personal rights due to staff opening their personal mail without prior consent.the state’s words, verbatim · CDSS document, Oct 23, 2024

Plan of correction: Licensee/Administrator shall read Title 22, Section 87468.1(a)(15) Personal Rights of Residents... and submit a statement acknowledging understanding of Title 22 Regulations by POC due date of 10/30/24 and email it to LPA Perry Scott at perry.scott@dss.ca.gov.

Type of visit: Required - 1 Year

On 06/20/24 Licensing Program Analyst’s (LPA’s) Villegas and Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Licensee Rodrigo Ramos as the purpose of the visit was explained. LPA’s were later joined by acting Administrator Shalani Ramos. The facility is licensed to serve 60 ambulatory and 60 non-ambulatory residents ages 60 and above. The facility has an approved hospice waiver for 10 residents. The current facility census is 46 residents in care. An active liability insurance was observed to have an expiration date of 04/09/25. Licensee was provided with information regarding the annual fee of $1,982 due by 06/26/24. The facility is two-story commercial building consists of sixty (60) resident bedrooms, sixty (60) resident bathrooms, six (6) common bathrooms, dining room, commercial kitchen, med room, library, washer and dryer/ storage area, backyard with umbrella with table and chairs, and administrative offices. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Toxins and knifes were stored and inaccessible to residents. Resident bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. Exits and walkways are free of debris/hazards, there are no weapons nor bodies of water on the premises. LPA’s conducted a records review of 5 staff records, 4 resident records, and 4 medication reviews. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 01/22/24, fire extinguisher fully charged, carbon monoxide and smoke detectors are interconnected and operational. LBFD conducted a fire inspection on 04/16/24, facility is in compliance. Deficiencies are cited on 809D page. Exit interview conducted, appeal rights explained to licensee, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 20, 2024

Type of visit: Case Management - Deficiencies

On 05/06/24 at 1pm Licensing program analyst (LPA) Villegas conducted a case management visit to issue deficiency for reporting requirements, LPA Met with Administrator Shalani Ramos as the purpose of todays visit was explained. On 04/30/24 LPA received two unusual incident reports, the first incident report was dated 04/17/24 but was not received by the department until 04/30/24 (13 days). The second unusual incident report was dated 04/19/24 but was not received by the department until 04/30/24 (11 days). Based of review of the incident reports the facility staff did not submit the unusual incident reports within 7 days of the occurrence as required by title 22. Deficiency cited under California code regulations, title 22, division 6, Chapter 8 are being cited on the attached LIC 809D. Exit interview conducted, appeal rights provided, and a copy of this report was provided to Administrator Shalani Ramos.the state’s words, verbatim · CDSS document, May 6, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 10, 2024

Each licensee shall furnish to the licensing agency... A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement is not met as evidet by, based on records review the licensee did not submit incident reports dated 4/17/24, and 4/19/24 to licensing within 7 days of the occurence. This poses potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 6, 2024

Plan of correction: Administrator to review title 22 reporting requirementsand self certify acknowledgement of the review. Administrator shall submit self certification by POC due date.

Type of visit: Case Management - Deficiencies

On 05/06/24 at 1pm Licensing program analyst (LPA) Villegas conducted a case management visit to issue deficiency for citations observed during complaint investigation 11-AS-20230811161937, LPA met with Administrator Shalani Ramos as the purpose of todays visit was explained. During the complaint investigation, LPA observed resident #1 (R1) had a change in condition and facility staff did not document such changes in residents record. Also, during complaint investigation during interviews conducted facility staff communicated with R1's physician when R1 refused medication but there was no documentation of the communication and the physicians directives. Deficiencies cited under California code regulations, title 22, division 6, chapter 8 are being cited on the attached 809D. exit interview conducted, appeal rights explained, and a copy of this report was provided Administrator Shalani Ramosthe state’s words, verbatim · CDSS document, May 6, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87566 · Plan of correction due date: May 13, 2024

Observation of the Resident ...When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physicians and the resident's responsible person, if any. Based on interviews conductedand reocrds reviewed, R1 had a change in condition in physical and mental functioning, and R1 was refusing meds and the licensee failed to document shuch changes. This poses a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 6, 2024

Plan of correction: Licensee shall develope a plan outlining the steps the facility will take when residents have change in conditions and how such changes shall be documented in residents file. Licensee shall submit plan to licensing by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(d)(2) · Plan of correction due date: May 13, 2024

Incidental Medical and Dental Care If the resident is unable to determine his/her own need for a prescription...The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. This requirement is not met as evident by based on interviews conducted and records review, the licensee failed to document contact with R1's physician when R1 refused medication(s). This poses a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 6, 2024

Plan of correction: Licensee shall develope a plan outlining the steps the facility will take to ensure documented contact with physician and physicans directions is maintained in rseidents records. Licensee shall submit plan to licensing by POC due date.

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

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 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.the state’s words, verbatim · CDSS document, Mar 6, 2024 · control 11-AS-20240229165254