197606145-6-23-2022-28-AS-FFIS-CQ5QCF-20230321120300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:25:55 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 Elizabeth Ceniceros

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:	DATE:	06/23/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Administrator, Pamela Parsons		TIME COMPLETED:	09:30 AM

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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Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Administrator (Pamela Parson). The purpose of this visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations. LPA/RA obtained copies of Resident #2’s Emergency Identification and Information, Physician’s Report, Medication Administration Record, Appraisal/Needs and Services Plan. LPA/RA toured the facility’s commercial kitchen and dining room area.

LPA Bonnie Tao conducted the virtual 10-Day Visit on 12/28/20. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, the complaint investigation was conducted telephonically with Administrator (Pamela Parsons). During the virtual, video conference call with Administrator Parsons, LPA Tao had conducted a virtual tour of the facility’s physical plant which included the kitchen, dining area, and activity room. LPA Tao interviewed Staff #1 (Administrator) and Resident #1 and requested pertinent documents: Residents & Staff Rosters, Staff Work Schedules,

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Araceli Ramirez	TELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

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-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: 06/23/2022

NARRATIVE

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Activities Calendar (December 2020), L.A. Co. DPH Activity Protocol, Facility’s Activity Plan for Christmas special event, and Dietary Protocol. Resident #1 (R1) Admission Agreement, Physician's Report, Identification and Emergency information, Care Plan, House Rules, Alternative Meal Delivery Procedure, Menus (November 29, 2020 - January 2, 2021), and Activities Calendar (December 2020). Resident #1’s Admission Agreement, Physician's Report, Identification and Emergency information, Resident’s Care Plan, Appraisal/Needs and Services Plan, Resident Assessment (06/02/20), Narrative Charting (05/04/20, 06/02/20, 06/03/20, 06/04/20, 06/05/20, 07/18/20), Individual Service Plan (IPP) Initial Assessment (06/02/20), and Assessment Plan. Resident #2’s Identification and Emergency information, Physician's Report, Appraisal/Needs and Services Plan.

Regarding Allegation #1: this investigation revealed that Resident#2 is wheelchair bound. Facility staff assists the resident with its ADLs whenever the resident needs care. A caregiver is assigned to the hallway for the resident. Facility Staff would assist Resident #2 to bathe, get dressed, assist in placing the resident in its chair, bring the resident food, conduct room checks, wash/dry/fold laundry, and administer its medications. A review of Resident #2’s Physician’s Report (dated 09/28/21) documented that the resident the resident requires assistance with its activities of daily living. The majority of interviews conducted with residents, corroborated that they have not observed facility not assisting residents with ADLs.

Based on the evidence gathered and interviews conducted and records reviewed, 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 of NEGLECT/LACK OF CARE: Facility not assisting resident with ADLs is found to be UNSUBSTANTIATED.

Regarding Allegation #2: this investigation revealed that the majority of the residents interviewed, corroborated that he/she do not recall having had a missed tray service delivered to his/her room when the dining room was shut down for communal dining. The majority of staff interviewed, corroborated that they did not receive complaints from residents regarding a meal not being served during the situation surrounding Coronavirus. A virtual tour of the facility’s physical plant included the kitchen, dining area, and food pantry that were in compliance.

SUPERVISOR'S NAME: Araceli Ramirez	TELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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: 06/23/2022

NARRATIVE

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did or did not occur; therefore, the allegation of PERSONAL RIGHTS: Facility did not provide lunch to residents is found to be UNSUBSTANTIATED.

Regarding Allegation #3: this investigation revealed that the majority of residents interviewed,corroborated that their meal delivery was being served in “to-go” style (Styrofoam containers with plastic utensils, cups,and paper napkins) to ensure food reaches the residents as hot as possible during the situation surrounding the Coronavirus when the dining room was shut down for communal dining. The majority of staff interviewed, corroborated that they did not receive complaints from residents regarding his/her food being served cold. A review of the facility’s menus were in compliance with food service; and, a virtual tour of the facility’s physical plant included the kitchen, dining area, food supply was in compliance.

Based on the evidence gathered and interviews conducted and records reviewed, 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 of FOOD SERVICE: Food served to residents is cold is found to be UNSUBSTANTIATED.

An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator (Pamela Parsons).

SUPERVISOR'S NAME: Araceli Ramirez	TELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022

LIC9099 (FAS) - (06/04)

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