197606145-5-30-2024-28-AS-RORN-D5XTWX-20240605150617

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 05/30/2024
Date Signed: 05/30/2024 11:12:52 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/24/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240524113755

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: 162	DATE:	05/30/2024
		UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Araceli Dimaguila - RN Supervisor		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facillity failed to provide resident's records to attorney

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit at the facility regarding the above allegation. LPA met with Araceli Dimaguila and explained the reason for the visit. Administrator arrived 10 minutes later.

The investigation consisted of the following: LPA requested copies of staff/resident roster. LPA reviewed file for resident #1(R1) and requested copies of identification and emergency sheet, admission agreement, physician’s report, power of attorney, release of information letter request dated 5/21/24, and authorization for the release of medical information letter. LPA interviewed administrator. LPA contacted R1’s power of attorney over the phone and contacted law firm representative.

The investigation revealed the following: Regarding allegation: Facility failed to provide resident's records to attorney. It is alleged that on 05/21/2024 law office requests the facility to produce R1’s records and have not been received.
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

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-20240524113755

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA GARDENS RETIREMENT HOTEL	FACILITY NUMBER: 197606145
	VISIT DATE: 05/30/2024

NARRATIVE

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Interview with administrator revealed that letter request for records was received by their accounting department on 5/24/24. Administrator was out of the facility from 5/24/24-5/27/24 and received the letter on 5/28/24. Upon returning administrator reviewed the letter and requested medical records staff to pull records from storage and put the records together to comply with the request. Due to the large amount of documents facility was not able to provide records by due date of 5/29/24. Based on documents reviewed, law firm letter - release of information dated 5/21/24 is stamped 5/24/24 which is when it was received by the facility. Per Health and Safety Code (HSC) facility is to provide records upon requested not exceeding two business days. Due to the holiday weekend facility was to provide records by 5/29/24. During my visit, R1’s records were available for review. However, older records are currently on storage and need to be pulled out. LPA contacted law firm and informed that facility’s administrator will provide records by 5/30/24 end of day. Administrator spoke with a law firm representative, who accorded that mailing the documents by end of day 5/30/24 was acceptable.

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 is UNSUBSTANTIATED.

Exit interview was conducted with Pamela Parsons and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC9099 (FAS) - (06/04)

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