197606145-1-10-2022-28-AS-FFIS-CC834D-20220304165459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606145
Report Date: 01/10/2022
Date Signed: 01/10/2022 12:34:25 PM

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
01/03/2022 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220103112145

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: 180	DATE:	01/10/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Araceli Dimaguila (Registered Nurse)		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility does not have adequate hot water available to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Araceli Dimaguila (RN) and explained the purpose of the visit.

During today's investigation, LPA obtained a copy of the Staff, Resident roster and repair invoice. LPA interviewed Staff #1, #2 and #3 in the conference room between 10:00 am to 10:37 am. LPA toured the facility with Staff #3 at 10:40 am, measured the water temperature in various bedrooms and interviewed Residents #1 to Resident #10 between 10:45 am to 12:00 pm in various locations of the facility .

In regards to the allegation: Facility does not have adequate hot water available to residents. LPA reviewed a copy of a service invoice dated 12/13/21 indicating a water pipe was replaced due to leakage. Services were rendered the same day on 12/13/21. Interviews with Staff indicate that in the past month the only water issue the facility experienced was on 12/13/21 and the problem was resolved with a water pipe replacement. Continue to LIC9099C......

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022

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-20220103112145

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: 01/10/2022

NARRATIVE

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LPA tested the water temperature in 11 different Resident bathrooms in different sections of the facility and water temperature in all bedrooms measured within Title 22 guidelines. LPA's interviews with 10 of 10 Residents indicate hot water is available in the facility.

Based on LPA's record review, observations and interviews, investigation revealed: 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 is unsubstantiated.

Exit interview conducted with David Chirikian and a copy of this report provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022

LIC9099 (FAS) - (06/04)

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