197606145-4-22-2022-28-AS-FFIS-CDX2NE-20220428173235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 04/22/2022
Date Signed: 04/22/2022 09:48:25 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/25/2021 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20211025125712

FACILITY NAME:	ARCADIA GARDENS RETIREMENT HOTEL		FACILITY NUMBER:	197606145
ADMINISTRATOR:	PAT REDNER		FACILITY TYPE:	740
ADDRESS:	720 W. CAMINO REAL		TELEPHONE:	(626) 574-8571
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	200	CENSUS: 171	DATE:	04/22/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Pamela Parsons, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff left resident on the floor for an extended period of time.
Facility staff do not allow residents to have visitors.

INVESTIGATION FINDINGS:

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***This licensing report supersedes the original complaint investigation report, dated 02/14/22. The findings remain as Unsubstantiated. ***

Licensing Program Analysts (LPAs) Tao and Calderon, conducted an unannounced subsequent complaint investigation for the allegations listed above on 04/22/22. An initial complaint visit was conducted on 11/03/21 and subsequent visits were conducted on 12/07/21 and 02/14/22. During today’s visit, LPA Tao met Administrator Pamela Parsons, and explained the purpose of today's visit, which was to deliver the investigation findings of the above-mentioned allegations.

The investigation consisted of the following: interviews with Staff #1 through Staff #6; interviews with Resident #1 through Resident #7, review of resident #1’s facility records and a tour of the physical plant. LPA obtained copies of the Staff and Resident Rosters; and Resident #1 file for review of relevant information.
(-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211025125712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA GARDENS RETIREMENT HOTEL	FACILITY NUMBER: 197606145
	VISIT DATE: 04/22/2022

NARRATIVE

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***This licensing report supersedes the original complaint investigation report, dated 02/14/22. The findings remain as Unsubstantiated. ***

In regard to allegation "Facility staff left resident on the floor for an extended period of time," it was alleged that R1 fell off the bed and was on the floor for an hour. Seven (7) out of seven (7) residents could not corroborate the allegation. Residents had no knowledge of the incident. Per R1's interview, R1 denied that R1 fell off the bed and left on the floor for an hour. Five (5) out of five (5) staff were not aware of the incident of the allegation. Staff interviews revealed no residents were left on the floor for an extended period of time. File review did not reveal incident happened on R1 related to the allegation. LPA did not observe residents fell off the bed and left on the floor for an extended period of time during the visit.

In regard to allegation "Facility staff do not allow residents to have visitors", it was alleged that facility staff did not allow resident #1 to have visitor#1 (V1), who was a former resident. Seven (7) out of seven (7) residents could not corroborate the allegation. Resident interviews revealed that five (5) out of seven (7) residents stated they have staff allow visitors who come for visits. Two (2) out of seven (7) residents stated their visitors may meet residents in the outdoor visiting area, due to the visitors being unvaccinated or not providing staff with proof of a recent PCR test with negative results. Five (5) out of five (5) staff denied the allegation. Per LPA’s interviews with Administrator Pamela Parsons, Administrator reported that R1’s family member, who has power of attorney (POA), provided Administrator with a letter dated 07/16/21, requesting that the facility not allow visitor #1 (V1) to visit with R1. Administrator informed LPA Tao that the Administrator was complying with POA’s letter and did not allow V1 to visit with R1 on 10/20/21. Per staff interview, staff notified R1 and asked R1 whether R1 wishes V1 to visit on 10/20/21. R1 did not want V1 to visit R1. V1 acted aggressively at the entrance and, therefore, Administrator called local law enforcement due to V1 behavior. Law enforcement arrived at the facility and did not arrest V1. Instead, law enforcement escorted V1 off the premises. Per LPA’s interview with R1, R1 informed LPA that R1 does not feel comfortable when V1 visits. Interviews with Administrator and R1’s POA confirmed that the facility did not have a court ordered restraining order in place to deny V1’s visits. LPA's review of R1s letter dated 01/18/22, indicates R1 does not wish V1 to visit R1 at the facility, however, the letter is prior to the 10/20/21 incident.

(-continued in LIC 9099 C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211025125712

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA GARDENS RETIREMENT HOTEL	FACILITY NUMBER: 197606145
	VISIT DATE: 04/22/2022

NARRATIVE

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LPA's review of facility’s unusual incident report dated 10/20/21, indicated that V1 went to the facility to visit with R1 and was met outside the facility by Administrator Parsons, who informed V1 that the facility was a private property and R1’s P.O.A. had instructed the facility to not allow visit from V1. Therefore, the investigation revealed that R1’s personal right to have visitors was not violated.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Administrator and a hard copy was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC9099 (FAS) - (06/04)

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