198602098-4-18-2022-28-AS-MVAO-CDNKRB-20220420080740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 04/16/2022
Date Signed: 04/18/2022 08:10:18 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
03/10/2020 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200310105817

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:	0	CENSUS: 0	DATE:	04/16/2022
		UNANNOUNCED	TIME BEGAN:	08:00 PM
MET WITH:			TIME COMPLETED:	10:11 PM

ALLEGATION(S):

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Facility staff yell at residents.
Resident is not getting showers.
Facility staff handled resident in a rough manner.
Facility staff failed to provide a comfortable environment for resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicol Wesley initiated a subsequent complaint investigation for the allegations listed above

Investigation consisted of the following: On 03/13/20 LPA Wesley requested a copy of the staff roster, resident roster and copies of specific documents, interviewed the Assistant Administrator Gemma Deoso

Regarding allegation: Resident is not getting showers, R1 reported that they are not getting showered 2 times a week like they are supposed and staff missed two of their shower days. LPA Wesley interviewed residents #2-#5(R2-R5) who said they are showered 2-3 times a week or more if required. Residents said that they receive enough showers and if they wished to be showered more than two times, all they have to do is let the staff know and they will accommodate. LPA Wesley interview staff #1 who advised that the residents have designated shower days. Staff advised that sometimes the residents do not want to be showered and they cannot violate
Continued LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2022

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-20200310105817

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: 04/16/2022

NARRATIVE

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their rights. Staff said if a resident refuses to shower they encourage them to get a bath and freshen them up during incontinence care.

Regarding allegation: Facility staff handled resident in a rough manner. R1 advised that staff #2(S2) handled them in a rough manner and pulled their plastic wristband roughly while assisting with adl’s. R2-R5 siad they have never experience staff handling them in a rought manner and said that staff are nice and treats them gentle with love and care. S2-S4 were interviewed and said that staff handle residents in a gentle manner and have not received any complaints indicating they were being rough to residents in caree

Regarding allegation: Facility staff yell at residents. R1 reported that they are yelled and screamed at by staff. R2-R5 said the staff treats them right and by they have never been yelled or screamed at and has never heard any other residents get yelled or screamed at. R2-R5 said that staff are really nice and treat them with respect. Staff were interviewed and said they do not yell or scream at residents or violate their rights and has never witnessed any other staff yell, mistreat any other residents in the facility

Regarding allegation: Facility staff failed to provide a comfortable environment for resident in care. R1 reported that they were awakened in the middle of the night by staff and was not able to go back to sleep because they had anxiety after being woke up. During the interview with staff they advised that they are required to do room checks every 2 hours or as needed. During the interviews with residents they advised that the staff performs room checks and incontinence care every two hours
Continued on LIC 9099C

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200310105817

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: 04/16/2022

NARRATIVE

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to make sure they do soil their garment in the middle of the night. R2-R5 advised that it does not make them feel uncomfortable and it does not disturb them when the staff come into their room and check on them. The residents said they are pleased that the staff checks on them to make sure they are safe and dry so they can get a comfortable sleep throughout the night.
LPA Wesley made several attempts to interview resident #1(R1) but was not successful. 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.

There are no deficiencies cited. A copy of this report was mailed to the address on file.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2022

LIC9099 (FAS) - (06/04)

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