197606145-3-14-2023-28-AS-FFIS-CQ5QCE-20230321120259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 03/14/2023
Date Signed: 03/14/2023 04:53:41 PM

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
12/18/2020 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20201218152356

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: 174	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Pamela Parsons, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility not assisting resident with ADLs.
Facility did not provide lunch to residents.
Food served to residents is cold.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. ***

Licensing Program Analyst (LPA) Tao conducted an unannounced subsequent complaint visit to the facility regarding the above-mentioned allegations. Upon arrival at the facility, LPA met Pamela Parsons, Administrator and explained the purpose of today’s visit.

On 12/28/20, LPA Tao conducted the initial investigation visit telephonically due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. LPA obtained resident roster, staff roster, facility’s house rules, resident #1’s (R1) Physician Report, R1’s Identification and Emergency Information, R1’s Appraisal, R1’s Care plan, R1’s Needs and Services Plan, R1’s Individual Service Plan (IPP) Initial Assessment (06/02/20), and R1’s Narrative Charting (progress report).
(- 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: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 28-AS-20201218152356

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: 03/14/2023

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. ***

LPA Tao also obtained R1’s Individual service plan (IPP), R1’s Admission Agreement, R1’s assessment plans, Activities and Outings guidance (December 2020), L.A. County, DPH Activity Protocol, Facility’s Activity Plan for Christmas special event, Dietary Protocol, Alternative Meal Delivery Procedure, Menus (November 29, 2020 - January 2, 2021), Activities Calendar (December 2020), resident#2 (R2)’s Assessment, R2’s Individualized Service Plan (IPP), R2’s Physician’s report, R2’s Move in Notification (6/2/20), R2’s personal rights, R2’s care plan, R2’s narrative charting, Dietary services (1/4/21) during facility’s COVID outbreak, DPH Outbreak Notification letter of COVID – 19 outbreak (12/16/20), and virtually toured the facility which included the kitchen, dining area, and activity room. In addition, LPA interviewed staff#1 (S1) and resident#1 (R1) telephonically.

On 06/23/22, LPA/Retired Annuitant (RA) Elizabeth Ceniceros conducted a subsequent visit at the facility, reviewed resident files and delivered findings. LPA/RA obtained copies of Resident #2 (R2)’s Emergency Identification and Information, R2’s Physician’s Report, R2’s Medication Administration Record, R2’s Appraisal/Needs and Services Plan. LPA/RA toured the facility’s commercial kitchen and dining room area.

On 03/14/23, LPA Tao conducted another subsequent visit. During the visit, LPA obtained copies of staff and resident rosters, reviewed residents’ files, interviewed staff and residents, conducted a facility tour, and delivered findings. LPA interviewed staff from staff #2 (S2) through staff #6 (S6) and residents from resident#2 (R2) to resident#13 (R13).

The investigation consisted of resident interviews, staff interviews, residents’ files review, facility tour, and LPA’s observation.

In regard of allegation, “facility not assisting resident with ADLs (activities of daily living)”, it was alleged that staff did not assist resident #2 (R2) with daily living activities needs and provide social activities. The investigation revealed the following: LPA interviewed resident#1(R1), resident said staff did not assist resident #2 (R2) with daily living activities needs and social activities. Twelve (12) out of thirteen (13) residents, including R2, interviewed could not corroborate the allegation. All staff interviewed denied the allegation. (- 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: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201218152356

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: 03/14/2023

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. ***

Per LPA/RA Ceniceros’ file review revealed that R2 had a caregiver to assist resident’s ADLs. A review of Resident #2’s Physician’s Report (dated 09/28/21) documented that R2 requires assistance with activities of daily living. Facility staff would assist R2 to bathe, get dressed, assist in placing the resident in resident’s chair, bring the resident food, conduct room checks, wash/dry/fold laundry, and administer R2’s medications. LPA Tao reviewed DPH Outbreak Notification letter, it stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting social activities. During today’s visit, LPA observed staff would assist residents when residents needed help. Therefore, there is not preponderance evidence to prove staff was not providing ADLs and social activities to residents.

In regard of allegation, “facility did not provide lunch to residents”, it was alleged that facility did not provide lunch at the dining room for communal dining and residents only got food tray services. The investigation revealed the following: LPA interviewed resident#1(R1), resident clarified the allegation was that residents did get meals on that day but not having the meal at the dining hall for communal dining. Twelve (12) out of thirteen (13) residents interviewed stated they did not recall missing tray services of meals. All staff interviewed denied the allegation. Per LPA/RA Ceniceros’ investigation, it revealed that residents did not complain about missing meal during lockdown period due to the situation surrounding Coronavirus. LPA Tao reviewed DPH Outbreak Notification letter, it stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting communal dining. On 12/28/20, a virtual tour of the facility’s physical plant was conducted including facility kitchen, dining room, and food pantry, they were observed to be in compliance. Therefore, facility had provided meal to residents.
In regard of allegation, “food served to residents is cold,” it was alleged that facility was not equipped to keep residents' food warm while in transit from the kitchen to residents’ rooms and food was cold when delivered to residents. The investigation revealed the following: LPA interviewed resident#1(R1), resident revealed the food was cold while in transit from the kitchen to resident’s room. Twelve (12) out of thirteen (13) residents interviewed stated their meals were warm and not cold when the meal tray delivered to their rooms. All staff interviewed denied the allegation.
(- 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: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20201218152356

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: 03/14/2023

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 06/23/22. The findings remain Unsubstantiated. ***

Staff interviewed revealed facility was followed DPH’s COVID protocol on food services and staff did not receive complaints from residents regarding his/her food being served cold. Per LPA/RA Ceniceros’ investigation, it revealed that residents’ meal delivery was being served in “to-go” style which they were served in Styrofoam containers with plastic utensils, cups and paper napkins, to ensure food reaches the residents as hot as possible during COVID -19 lock down when the dining room was shut down for communal dining. A review of the facility’s menus were in compliance with food service. As mentioned above, DPH Outbreak Notification letter stated facility had COVID – 19 outbreak on 12/16/20 which facility was lock-down and required to follow COVID -19 protocol on restricting communal dining. Per file review, facility had set up and followed Dietary Protocol, Alternative Meal Delivery Procedure, and dietary Menus during COVID lock-down period. Therefore, there is not preponderance of evidence to prove the facility had served food to residents when food was cold.

Although the allegations may have happened or are 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. A hard copy of the reports was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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