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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 01/29/2021
Date Signed: 01/30/2021 02:14:50 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
10/13/2020 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201013101205
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: 64DATE:
01/29/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lourdes GarciaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Resident's needs are not being met due to a shortage of staff.
Resident is left in soiled diapers.
Resident does not receive meals in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra initiated a complaint investigation for the allegations 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 Lourdes Garcia (Facility Administrator). The initial complaint investigation was conducted on 10/21/2020.

On 10/21/2020, at approximately 11:00A.M, LPA Irra interviewed the Facility Administrator. LPA requested copies of documents for review.

During today’s investigation, the Activity Director, Staff #1 through Staff #6 (S-1 through S-6) and Resident #1 through Resident #6 (R-1 through R-6) were interviewed.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
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 3
Control Number 28-AS-20201013101205
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: 01/29/2021
NARRATIVE
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Allegation: Resident's needs are not being met due to a shortage of staff. During this investigation, the Facility Administrator, Staff 1 through Staff 6 (S-1 through S-6), Activity Director and Residents #1 through Resident #6 (R-1 through R-6) were interviewed. Interviewed staff indicated there is not a shortage of staff. Interviewed staff indicated there are (4) caregivers, (4) housekeepers, (1) med tech, (1) Activity Director, (1) Receptionist and (6) kitchen staff during the morning and afternoon hours. Interviewed staff indicated there are (2) caregivers, kitchen personnel and (1) med tech in the night shift as residents sleep through the night. Interviewed staff indicated they conduct rounds/check on residents every hour or 2 hours. Interviewed staff indicated that the 1 hour rounds are conducted for residents that require continuous assistance of activities of daily living including residents that are considered a “fall risk” and residents that have been recently discharged from the hospital. Interviewed staff indicated residents that do not require continuous assistance are monitored every (2) two hours. Interviewed staff indicated they are assigned residents to assist and a log (which covers is completed by the end of the shift. Interviewed Residents indicated they observe the facility having enough staff. Interviewed Residents indicated that staff meet their needs. Interviewed Residents did not express any concerns in regards to staffing. Staff and Resident interviews do not corroborate this allegation.

Allegation: Resident is left in soiled diapers.
During this investigation, the Facility Administrator, Staff 1 through Staff 6 (S-1 through S-6), Activity Director and Residents #1 through Resident #6 (R-1 through R-6) were interviewed. Interviewed staff indicated they have not received any concerns pertaining to incontinence care/changing of soiled diapers. Interviewed staff indicated that the 1 hour rounds are conducted for residents that require continuous assistance of activities of daily living including residents that are considered a “fall risk” and residents that have been recently discharged from the hospital. Interviewed staff indicated residents that do not require continuous assistance are monitored every (2) two hours. Interviewed staff indicated they are assigned residents to assist and a log is completed by the end of the shift. Interviewed staff indicated they assist residents with dressing, showering, incontinence care, provide medication. Interviewed Residents indicated staff provide them with assistance in activities of daily needed on a timely manner. Interviewed Residents did not have any concerns. Staff and Resident interviews do not corroborate this allegation.


Refer to LIC 9099C for additional information.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20201013101205
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: 01/29/2021
NARRATIVE
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Allegation: Resident does not receive meals in a timely manner.

During this investigation, the Facility Administrator, Staff 1 through Staff 6 (S-1 through S-6, Activity Director and Resident #1 through Resident #6 (R-1 through R-6) were interviewed. Interviewed staff indicated they have not received any concerns pertaining to not providing meals in a timely manner. Interviewed staff indicated meals are taken to the residents’ rooms. Interviewed staff indicated meals times are as following: 7:30AM-8:30AM breakfast, 11:30AM-12:30PM lunch and 4:30PM-5:30PM dinner. Interviewed staff also indicated that the residents are offered snacks such as sandwiches, fruit, cookies, juice. Interviewed staff indicated that there are staff assigned to deliver food to residents at their room. Per staff interviews, kitchen personnel assist with delivering the meals. Interviewed Residents indicated meals are delivered by kitchen staff to their room. Interviewed Residents indicated meals are provided in a timely manner. Interviewed Residents are indicated that they have can substitute food items (by submitting a request at the front office).

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.



A telephonic exit interview was conducted with the Facility Administrator, a hard copy was provided via e-mail for signature and Appeal Rights were provided
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3