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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 06/02/2020
Date Signed: 06/02/2020 02:49:20 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
09/26/2019 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20190926103516
FACILITY NAME:ARCADIA RETIREMENT VILLAGEFACILITY NUMBER:
198602098
ADMINISTRATOR:LOURDES GARCIAFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE ROADTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:149CENSUS: 90DATE:
06/02/2020
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Lourdes Garcia, AdministratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff abandoned resident.
Facility withheld residents belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza initiated a subsequent complaint investigation to deliver findings on the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Lourdes Garcia.

The investigation consisted of the following: On 10/3/2019 an initial 10-day complaint visit was conducted. Staff (S1-S3) were interviewed. Resident (R1) no longer lived at the facility, and was not interviewed. R1's file documents were reviewed and obtained: [Identification and Emergency Information, Admission Agreement, Resident Appraisal, Physician's Report, Client/Resident Personal Property and Valuables, Additional Valuables Inventory List - dated 4/19/2016, 4/21/2016, 4/27/2016, 4/27/2016, Eviction Notices, Letter to SW at Santa Anita Convalescent Hospital, daily Department Head Meeting, staff and client rosters. On 6/1/2020 & 6/2/2020, staff (S1 & S4) was interviewed. On 6/2/2020, Skilled Nursing Facility was contacted.
**** See LIC 9099C for continuation of report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020
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 2
Control Number 28-AS-20190926103516
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 RETIREMENT VILLAGE
FACILITY NUMBER: 198602098
VISIT DATE: 06/02/2020
NARRATIVE
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Allegation: "Staff abandoned resident." Based on interviews conducted and information obtained the findings indicate that resident (R1) was transported to the hospital as a result of a medical emergency. Resident (R1) was transferred to Santa Anita Convalescent Hospital (skilled nursing facility- SNF) due to higher level of care need. R1 was not discharged from the SNF back to the RCFE. The resident's medical issues prevented R1 from returning to the facility. Interview with SNF staff revealed that R1 was admitted on 4/12/2016, and continues to reside at SNF as a Long Term patient. A total of four (4) facility staff were interviewed. Administrator stated that the resident was not discharged from the facility until May 2017, because SNF social worker contacted the facility and advised staff that R1 would be returning to the facility. Administrator stated that in order to prevent issues with SNF or Licensing, R1 was not issued a discharge notification until after one (1) year. The evidence suggests this allegation is not supported.

Allegation: "Facility withheld residents belongings." Based on record review and interviews conducted resident (R1) resided at the facility up until April 2016. The resident was discharge from the hospital to a SNF. Resident's personal belongings were kept at the facility as a courtesy for over one (1) year. Per Admission Agreement page 12, "The Community shall be entitled to remove promptly and store all property from your Apartment, at your expense, when you permanently vacate your Apartment. The community shall give you or your estate ten (10) days' written notice of such removal, and shall eventually dispose of your property as provided by law if not claimed. (Move Out Policy). Admission agreement noted that R1 declined to have personal items inventoried upon admission. The facility is not required to store resident's belongings for over a year. According to staff interviews, R1 sent two (2) persons to pick-up belongings during a weekend. However the facility was not notified, and the items were not released; facility housekeeper did not have authorization to release the items. The facility contacted R1's social worker, and a small amount of personal belongings were picked up. According to staff interviews, another SNF social worker contacted the facility to inform Administrator that R1's personal belongings would be picked up. Two weeks passed, and R1's belongings were never picked up. The belongings were moved from the hallway, and not discarded. Resident (R1's) belongings remained in storage for a long time. Pest control company discovered that R1's belongings were infested with cockroaches. As a result, the facility discarded the personal belongings that were left at the facility for over one (1) year.

Based upon record review, and interviews conducted the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated.

A telephonic exit interview was conducted with Administrator Lourdes Garcia. A hard copy of the report was emailed. Staff was instructed to sign the LIC 9099 reports and return to LPA.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020
LIC9099 (FAS) - (06/04)
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