198602098-9-23-2021-28-AS-FFIS-C768SR-20210923224645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 08/28/2020
Date Signed: 09/23/2021 05:18:00 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
08/21/2020 and conducted by Evaluator Bonnie Tao

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200821120543

FACILITY NAME:	ARCADIA RETIREMENT VILLAGE		FACILITY NUMBER:	198602098
ADMINISTRATOR:	LOURDES GARCIA		FACILITY TYPE:	740
ADDRESS:	607 WEST DUARTE ROAD		TELEPHONE:	(626) 447-6070
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	149	CENSUS: 91	DATE:	08/28/2020
		UNANNOUNCED	TIME BEGAN:	09:58 AM
MET WITH:	Virgil Agas, Administrator, Justin Lee, Administrator Assistant		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Due to lack of adequate supervision, resident has eloped from the facility on multiple occasions.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the original complaint investigation report created on 08/28/20 ****

The purpose of this report is to clarify the complaint investigation. The finding shall remain the same and this was discussed with Administrator, Virgil Agas.

Licensing Program Analyst (LPA) Tao conducted an initial 10-day visit on 08/28/2020 and delivered finding on the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, the initial complaint investigation was conducted telephonically with Administrator Lourdes Garcia, staff and residents. The purpose of the visit was discussed with Administrator.

(-see LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

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-20200821120543

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: 08/28/2020

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 08/28/20 ****

The investigation consisted of a virtual tour of the physical plant along with a health and safety check. LPA conducted interviews with Resident #1 (R#1), Administrator (Staff #1), Staff #2, Staff#3, Staff #4, and Staff #5. LPA reviewed R#1’s special incident reports and R#1’s file, including Resident's Needs and Services plan, Resident Appraisal, Administrator note dated 07/28/20, and Physician Report dated 08/10/20.

Regarding allegation: Due to lack of adequate supervision, resident has eloped from the facility on multiple occasions.

The investigation revealed that per the incident reports dated 07/27/20 and 08/10/20, R#1 had a pattern of leaving the facility without notifying staff. Upon staff discovering R#1 was missing, the facility staff contacted local law enforcement to file a missing person’s report. The facility self-reported R#1’s Absent Without Leave (AWOL) behaviors to the department via incident reports dated 08/10/20 and 07/27/20.

Per LPA’s interview with R#1, LPA confirmed that R#1 was leaving the facility without notifying staff of R#1 whereabouts. LPA’s interviews with staff, revealed that staff were present in the facility and were providing care and supervision to R#1 as needed. Staff were reminding R#1 of the risk of leaving the facility during the current Pandemic. Staff were encouraging all residents to stay in the facility and reminding the risk of leaving the facility during the current Pandemic. Interviews with five (5) out of five (5) staff interviews indicated that when staff observed R#1 may leave the facility, the staff would speak with R#1 and attempt to redirect R#1 from leaving the facility. However, the investigation did not reveal that staff violated R#1 personal rights by re-directing R#1 from leaving the facility. R#1 could leave the facility unassisted at any time.

LPA’s review of staff records indicated staff are trained on how to work with residents who have tendency of leaving the facility without notifying staff. Therefore, the investigation revealed that staff provided R#1 with adequate supervision and R#1 was able to leave facility unassisted. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Virgil Agas, Administrator.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021

LIC9099 (FAS) - (06/04)

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