198602098-10-20-2022-28-AS-FFIS-CLB3NN-20221118172410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 10/20/2022
Date Signed: 10/20/2022 05:25:27 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:	0	CENSUS: 83	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Gil Agas, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not provide adequate food service to residents.

INVESTIGATION FINDINGS:

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***This licensing report supersedes the original complaint investigation report, dated 06/23/20. The finding has remained as Unsubstantiated. ***

Licensing Program Analyst (LPA) Tao conducted unannounced subsequent complaint investigation for the allegations listed above on 10/20/22. An initial complaint visit was conducted on 6/22/20 and subsequent visits were conducted on 6/23/20. During today’s visit, LPA met Administrator. LPA explained the purpose of today's visit is to do additional interviews, obtain document and deliver findings of the above-mentioned allegation.

Investigation consisted of the following: interviews of Staff from Staff #1 through Staff #7; interviews of residents from resident #1 through resident #11; facility record reviews, and a facility tour. LPA obtained copies of staff and resident rosters; and resident files for resident #1 (R1) with relevant information.
(-continued in LIC 9099 C-)

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: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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-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: 10/20/2022

NARRATIVE

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***This licensing report supersedes the original complaint investigation report, dated 06/23/20. The finding has remained as Unsubstantiated. ***

The investigation revealed the following:
In regard to allegation "staff do not provide adequate food service to residents", it was alleged that food provided at the facility was not good. Seven (7) out of eleven (11) of the interviewed residents indicated that they like the food provided at the facility. The quality of food was acceptable to residents. Four (4) out of eleven (11) residents could not corroborate the allegation. All staff interviewed denied the allegation. Staff interviews revealed they make food for residents and prepared it based on residents' needs. LPA observed that residents' food tray had variety of food. Resident were able to get a second round of food per their requests. The facility had weekly menu and alternate food selections weekly. Residents could have options of having their meals in pieces or pureed. Per record review, facility had alternative menu / food options to residents if they did not like what was being served. Based on records reviewed and interviews conducted, the facility provided three meals and snack every day to residents. Therefore, food services provided at the facility was adequate.

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.

An exit interview was conducted with Administrator. A hard copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC9099 (FAS) - (06/04)

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