198602098-6-23-2020-28-AS-FFIS-CLB3NP-20221118172410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 06/23/2020
Date Signed: 06/23/2020 04:44:13 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
06/16/2020 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20200616154245

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: 89	DATE:	06/23/2020
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator Assistant, Staff #1 (S1)		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not provide adequate food service to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Assistant Administrator, Staff #1.

The investigation revealed the following:
Allegation: Staff do not provide adequate food service to residents.
Based on records reviewed and interviews conducted, the facility provided three meals and snack every day to residents. The facility has alternative options to residents if they do not like what is being served for the day. Residents are able to get a second round of food per their requests. There are seven (7) out of eleven (11) of the interviewed residents indicated that they like the food provided by the facility. The quality of food is acceptable to them. Staff interviews revealed they make specialized diets for certain residents and they prepared food based on their needs. (continued in LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020

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-20200616154245

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: 06/23/2020

NARRATIVE

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The facility has weekly menu and they alternate food selection weekly. Residents can have options of having their meals in pieces or pureed. Therefore, there is insufficient evidence to support the allegation.
Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

A telephonic exit interview was conducted with Administrator Assistant (S1), and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020

LIC9099 (FAS) - (06/04)

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