197606145-11-9-2022-28-AS-RORN-CLLMNZ-20221128084615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 11/09/2022
Date Signed: 11/09/2022 12:13:44 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
08/02/2022 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220802163705

FACILITY NAME:	ARCADIA GARDENS RETIREMENT HOTEL		FACILITY NUMBER:	197606145
ADMINISTRATOR:	PAMELA PARSONS		FACILITY TYPE:	740
ADDRESS:	720 W. CAMINO REAL		TELEPHONE:	(626) 574-8571
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	200	CENSUS: 170	DATE:	11/09/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Assistant Administrator Araceli Dimaguila		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Facility is not allowing resident to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Assistant Administrator Araceli Dimaguila and explained the reason for the visit.
At today's visit Resident R 1 was interviewed at 9:45 AM.
The initial visit was conducted on 08/09/2022 and the following was done:
LPA conducted an interview with Executive Director Pamela Parsons at 9:30 AM . LPA collected copies of Staff and Resident Rosters. LPA reviewed Resident 1 (R1) file and requested copies of pertinent documents related to complaint allegation.
LPA interviewed Resident R1- R6 from 10:00 AM to 12:00 PM.
Subsequent visit was conducted on 10/13/2022 and included Resident R 1 was interviewed at 9:50 AM.
At 10:30 AM family member for R 1 was interviewed.
Interview was conducted with Owner Julie Chirikian and also with the Consultant for the facility at 11:00 AM.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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-20220802163705

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: 11/09/2022

NARRATIVE

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In regards to the allegation Facility is not allowing resident to have visitors, based on interviews conducted and information gathered with residents, staff, Power of Attorney, and review of various documents from Resident's 1 file, Resident R 1 was interviewed on 3 visits 11/09/22, 10/13/22 and 08/09/22 and stated that Individual # 1 is a very good friend and helps her out. Stated she doesn't understand why they don't want him to see her.
Stated that yes she does want him to visit her at the facility.
Stated he respects her and if she tells him no he won't do it.
Power of Attorney documentation dated 11/17/2018 does not state a restriction for visitation.
Resident R 3 stated that Individual # 1 would not hurt her and has not seen anything bad between the 2 of them.

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.

Assistant Administrator refused to sign the report.

Exit interview conducted and copies provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220802163705

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: 11/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 11/10/2022 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	Personal Rights Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon.	1 2 3 4 5 6 7	Facility to submit by POC due date to licensing self-certification that facility will allow Individual # 1 and all visitors to visit during reasonable hours
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews conducted and file review licensee failed to have Individual # 1 be permitted to visit which causes an Immediate Health and Safety Risk to Residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

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