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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 04/13/2022
Date Signed: 04/13/2022 06:34:31 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,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/05/2020 and conducted by Evaluator Antonia Alvizar
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201005083337
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:0CENSUS: 74DATE:
04/13/2022
UNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Virgilio AgasTIME COMPLETED:
04:52 PM
ALLEGATION(S):
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Facility does not provide resident a safe and comfortable environment.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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On 04/13/2022 Licensing Program Analyst (LPA) Antonia Alvizar and Licensing Program Manager (LPM) Ulysses Coronel conducted a subsequent complaint investigation on a complaint made against the former licensee. LPA Alvizar and LPM Coronel met with administrator Virgilio Agas who was employed as the incoming administrator during the time of the complaint allegations.

The investigation consisted of the following: On 10/13/2020 LPA Bonnie Tao conducted a telephone interview with administrator Lourdes Garcia and staff S#2 and obtained staff and resident records. On 04/13/2022 LPA Alvizar and LPM Coronel interviewed Administrator Agas, 4 out of 74 residents and 4 staff, reviewed resident, staff, and facility records and conducted a tour of the facility.

Report continued, please see LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
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-20201005083337
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: ARCADIA RETIREMENT VILLAGE
FACILITY NUMBER: 198602098
VISIT DATE: 04/13/2022
NARRATIVE
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The investigation revealed the following: Regarding the allegation “Facility does not provide resident a safe and comfortable environment.” During interviews conducted, 1 out of 4 residents agreed with the allegation, resident R1 stated “Whenever I call to get assistance to transfer from my bed to my chair they take a long time.” 3 out of 4 residents disagreed with the allegation, resident R4 stated “I feel safe and comfortable in here, they provide me with assistance when I need it.” 5 out of 5 staff interviewed disagreed with the allegation staff S3 stated “I have not heard about that complaint, I make sure that the resident are comfortable and the residents feel safe.” Facility does not provide resident a safe and comfortable environment.” Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Regarding the allegation: “Facility is in disrepair.” During interviews conducted, 4 out of 4 residents disagreed with the allegation, on 04/13/2022 resident R1 stated “Usually they are good at it, the administrator gets anything fixed within a day.” R4 stated “Maintenance are pretty good, when something is broken it gets repaired in a reasonable amount of time.” 5 out of 5 staff interviewed disagreed with the allegation staff S2 stated “The administrator always repairs things by the next day”. Regarding the allegation “Facility is in disrepair.” Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

No deficiencies cited. An exit interview was conducted and a copy of this report was provided to Virgilio Agas and mailed to former licensee Dr. Mohamed Seilami.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Antonia AlvizarTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022
LIC9099 (FAS) - (06/04)
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