198602098-4-15-2022-28-AS-LHIS-CE4TWK-20220504150539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 04/15/2022
Date Signed: 04/15/2022 01:54:26 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
07/09/2020 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200709164705

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: 74	DATE:	04/15/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Gil Agas		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Resident sustained a broken leg while in care.
Staff left the residents alone without supervision.
Licensee did not notify responsible party of serious health incident.
Facility did not communicate with the resident's authorized representative promptly or appropriately.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Administrator, Gil Agas who assisted with today's visit.

Regarding the allegation that Resident #1 sustained a broken leg while in care, the investigation was conducted by the Department, which included interviews with Staff, residents, and review of resident #1's hospital records. The investigation revealed that resident #1 fell in her room on 7/4/2020. At the time of the incident, resident #1's care plan indicated that she was independent in bathing, dressing, and personal hygiene. Facility staff statements and hospital records show consistent timelines which show that proper care was provided for resident #1 after the fall. Regarding the allegation that Staff left the residents alone without supervision, the investigation consisted of interviews with Staff, and residents. Staff interviewed, deny the allegation. They stated that residents have never been left alone without supervision. Residents interviewed were unable to corroborate the allegation. They stated that there is always staff present at the facility. Resident #1's family member stated that he did not believe that residents are being neglected at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

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-20200709164705

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: 04/15/2022

NARRATIVE

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Regarding the allegations that licensee did not notify responsible party of serious health incident, and facility did not communicate with the resident's authorized representative promptly or appropriately. The investigation consisted of interviews with Resident #1's authorized representative, and facility staff. Staff interviewed denied that Resident #1's authorized representative/responsible party was not contacted. Staff interviewed stated that it is their policy to always contact the resident's responsible party any time a resident is involved in a serious injury. Resident #1's responsible party stated that he did not have concerns regarding the care his mother is receiving at the facility.

Based on LPA's observations and interviews, investigation revealed: 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.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Gil Agas.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022

LIC9099 (FAS) - (06/04)

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