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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 05/19/2021
Date Signed: 05/19/2021 06:31:02 PM

Substantiated


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
05/14/2021 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20210514114040
FACILITY NAME:ARCADIA GARDENS RETIREMENT HOTELFACILITY NUMBER:
197606145
ADMINISTRATOR:PAT REDNERFACILITY TYPE:
740
ADDRESS:720 W. CAMINO REALTELEPHONE:
(626) 574-8571
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 169DATE:
05/19/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Pamela Parsons, Administrator, and
Araceli Q Dimaguila		TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility has pests.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Tao, conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPAs met with Araceli Q Dimaguila, and was later joined by the Administrator. LPAs explained the purpose of today’s visit is to discuss the above mentioned allegations.
The investigation consisted of resident interviews, staff interviews, facility tours, review of facility records, and medical records.
Facility tour for physical plant inspection was conducted. At the time of the inspection, pests were not observed. However, Staff interview and residents interviews revealed that pests was found in residents’ bathrooms. Five (5) out of thirteen (13) residents interviewed reported seeing pests in their bathrooms. Review of pest control documents and invoices revealed that facility received services monthly.
Based on review of documents and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 1. See LIC 9099D.

An exit interview was conducted with Administrator. A hard copy of the report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20210514114040
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2021
Section Cited
CCR
80087(a)(1)
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80087(a)(1). Buildings and Grounds. The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met by evidence of:
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Licensee shall provide facility with pest control service monthly to control pests. Services invoices Jan 2021 to April 2021 were provided. POC was cleared at visit
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Based on interviews conducted the findings indicate there have ants sighting in resident bathrooms. Administrator stated that a pest control company services monthly.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3