197606145-6-23-2022-28-AS-FFIS-CVMUE8-20230913153038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:26:55 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
10/04/2021 and conducted by Evaluator Elizabeth Ceniceros

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211004122114

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: 179	DATE:	06/23/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator, Pamela Parsons		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff is not dispensing resident's medication as prescribed.

Staff are not serving a good quality of food.

Facility has ants.

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 Parsons). The purpose of today’s visit is to conduct a subsequent visit and to deliver the findings pertaining to the above-mentioned allegations. LPA/RA obtained copies of Resident and Staff rosters and toured the facility’s commercial kitchen, dining room area, and residents’ bedroom.

LPA Bonnie Tao conducted an unannounced 10-Day visit on 10/08/21. LPA met with Administrator (Pamela Parsons). During the visit, LPA Tao interviewed Staff#1 thru Staff #6, Resident #1 and Resident #7. A physical plant tour of the facility was conducted that included residents’ rooms #309-D and #164-E. LPA Tao obtained copies of the Residents and Staff Rosters, In-Service Training (Insulin Administration) Records, Pest Control Service Agreement, and Pest Control Company Invoices; R1's Admission Agreement, Pre-Appraisal, Emergency Identification and Information, Physician’s Report, Medication Administration Record (09/2021, 10/2021), Appraisal/Needs and Services Plan.

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-20211004122114

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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Regarding Allegation #1: this investigation revealed that the facility’s LVNs administer Resident #2’s prescribed medication (Insulin). LVN will follow the resident’s chart to administer the medication and observe the resident when taking the medication. LVN will check the resident’s blood sugar (between 7:30 a.m. to 8:00 a.m.). NOC shift LVNs administers the resident’s medication (Insulin) on Fridays and Saturdays. During the weekday, the morning shift LVN administers Resident #2’s medication (Insulin). Resident #2’s blood sugar reading is a daily check and posted in the medication administration record (MAR). The MAR records the blood sugar and determines whether the resident’s medication (Insulin) administration is needed. The unit of medication (Insulin) from the pen is given (based on the MAR) and is a fixed amount per doctor’s orders. After the medication (Insulin) is given to Resident #1, the LVN will check off the medication in the medication computerized system which keeps track of the prescribed medication (Insulin). The medication (Insulin) dosage is determined by the resident's physician; and, it’s a fixed dosage. A review of the Medication Administration Record (MAR) documented Resident #1 received its blood glucose check (from 09/01/21 to 09/30/21) at 7:30 a.m. and at 4:30 p.m. and prescribed medication [Novolin 70-30 VL (10ML)] administered at 8:00 a.m. (from 09/01/21 to 09/30/21). Resident #1 received its blood glucose check (from 10/01/21 to 10/08/21 at 7:30 a.m. and 4:30 p.m. and prescribed medication [Novolin 70-30 VL (10ML)] administered at 8:00 a.m. (from 10/01/21 to 10/08/21). A review of the facility’s in-service training records documented the facility offered training on 08/15/21 to facility LVNs presented by Staff #2 (LVN Director) regarding the topic: “Insulin Administration”.

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 MEDICATION: Staff is not dispensing resident’s medication as prescribed is found to be UNSUBSTANTIATED.

Regarding Allegation #2: this investigation revealed based on interviews conducted of residents, the majority corroborated that the facility’s food service is good and there were no issues with the quality of food service. The majority of interviews conducted with staff, corroborated that they had not received complaints from residents regarding the quality of food service. A virtual tour of the facility’s physical plant included the kitchen, dining area, food supply; and, a review of the facility’s menus are all in compliance. During the subsequent visit, LPA/RA Ceniceros conducted a tour (together with Administrator Parsons) of the commercial kitchen, dining room area, and residents’ bedroom.

Based on the evidence gathered and interviews conducted and records reviewed, although the allegation

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-20211004122114

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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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 FOOD SERVICE: Staff are not serving a good quality of food is found to be UNSUBSTANTIATED.

Regarding Allegation #3: this investigation revealed based on interviews conducted of residents, the majority corroborated that they have not seen ants in his/her bedroom or in his/her food. Interviews conducted of staff members, the majority corroborated that they may have received complaints from residents observing ants in their rooms or in their food. During the initial visit conducted by LPA Bonnie Tao, no ants were observed in the reporting party’s room. LPA/RA Ceniceros conducted a tour of the facility’s commercial kitchen, dining room area, and residents’ bedroom and did not observe ants in the various locations. The facility has a monthly contract with a pest control company that conducts services.

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 PHYSICAL PLANT: Facility has ants 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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