198602098-12-12-2022-28-AS-RORN-CMAQGL-20221220110941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 12/12/2022
Date Signed: 12/12/2022 02:44:20 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/27/2020 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200727134657

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: 0	DATE:	12/12/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Justin Lee		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained injuries while in care.
Facility did not report unusual incident(s) which threatened the physical health of resident
Facility did not maintain adequate staffing to meet resident's needs.
Staff did not meet incontinence needs of resident.
Staff spoke inappropriately to resident.
Staff is not serving food of the quality or quantity to meet resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Business Manager Justin Lee and explained the reason for the visit.

The facility is under a new change of ownership, effective 02/24/21; therefore, LPA Gonzalez will mail findings to (former) Licensee.

The investigation consisted of: During the initial visit conducted on 7/28/20, LPA Gonzalez conducted televisit via Facetime with Administrator Lourdes Garcia for the purpose of conducting a health and safety check. LPA Gonzalez and Administrator Garcia toured the facility. Health and safety check included a tour of the entire facility including medication room, activity room, dining room and outside smoking area. LPA did not

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

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-20200727134657

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198602098
	VISIT DATE: 12/12/2022

NARRATIVE

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observe any signs of neglect, abuse or other immediate health and safety threats. LPA requested and received copies of Staff and Resident Rosters, Facility 4 week menu, Staff Schedules for June - July 2020, and Resident Rounds Sheets for July 2020. On 4/45/22, LPA Luis Mora conducted telephone interviews with Residents 2-8 (R2-8) and Staff 1- 5 (S1-5). On 12/6/22, LPA Gonzalez reviewed facility file in regards to previously reported Unusual Incident/ Injury Reports. On 12/12/22, LPA Gonzalez interviewed Business Manager Justin Lee, R9-14, conducted a tour of the facility which consisted of inspection of facility lobby, kitchen, dining room, a random selection of resident rooms. LPA additionally collected copies of Staff and Resident rosters, Facility Menu, reviewed R1 and R9-14 facility files and collected copies of pertinent documents. LPA attempted phone calls with R1 Family Members 1-2 (R1 FM 1-2), LPA left voice mails for return calls and did not received a call back during the time of LPA visit.

Investigation revealed the following: Regarding allegations, Resident sustained injuries while in care and Facility did not report unusual incident(s) which threatened the physical health of resident, it is alleged that on or around March 2020 a resident (R1) sustained a fall and bumped their head and as of July 27, 2020 the resident still has a bump on their head and suffers from migraines due to the head injury. This fall was allegedly never reported it to Community Care Licensing (CCLD). Interviews conducted with 4 out of 6 staff revealed that R1 did not sustain a fall during the time the resident resided in the facility. 2 out of 6 staff stated that they did not work at the facility when R1 was a resident but stated that if a resident falls facility staff will tend to the resident and provide first aid but if a higher level of medical attention is needed the resident will be sent to the hospital. 6 out of 6 staff stated that incident reports are sent in a timely manner when an incident occurs in the facility that requires reporting to CCLD. Interviews conducted with 12 out of 13 residents revealed that facility staff meet their needs. 1 resident refused to continue interview and R1 is no longer a resident of the facility. 13 out of 13 residents stated that staff respond quickly if they need assistance. 11 out of 13 residents stated that staff conduct rounds and check in on residents every 2 hours. 1 resident stated that they do not know how often staff conduct rounds and 1 resident stated that staff do not conduct rounds in a timely manner. LPA reviewed facility Unusual Incident/ Injury Reports for April 2020 - July 2020 and observed that facility was appropriately reporting any facility incidents regarding resident falls and or any other unusual incidents in a timely manner. LPA did not observe an Unusual/ Injury Reports regarding R1 for the alleged fall that occurred in March 2020. Based on interviews conducted with facility staff, facility residents, and LPA review of records, there was not enough supportive evidence to concur with the reported allegation.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200727134657

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198602098
	VISIT DATE: 12/12/2022

NARRATIVE

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For the allegation, Facility did not maintain adequate staffing to meet resident's needs, it is alleged that the facility does not have adequate staffing to provide adequate care and supervision to facility residents and that facility staff do not respond to resident's calls in a timely manner. Interviews conducted with 6 out of 6 staff revealed that the facility has enough staff on schedule to meet the needs of the facility residents. Staff stated that there are 3 staff per shift and staff conduct rounds every two hours as well as respond to client calls as needed. Interviews conducted with 12 out of 13 residents revealed that the facility has enough staff on schedule and that facility staff meet their needs, 1 resident stated that there should be more staff on schedule and R1 is no longer a resident of the facility. 13 out of 13 residents stated that staff respond quickly if they need assistance. 11 out of 13 residents stated that staff conduct rounds and check in on residents every 2 hours. 1 resident stated that they do not know how often staff conduct rounds and 1 resident stated that staff do not conduct rounds in a timely manner. LPA reviewed facility schedule and observed that there are enough staff on schedule to properly oversee clients, facility operation and tend to residents daily needs. LPA also reviewed Resident Rounds Sheets for July 2020 and observed that staff conduct adequate rounds which occur approximately every 2 hours. Based on interviews conducted with facility staff, facility residents, and LPA record review, there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Staff did not meet incontinence needs of resident, it is alleged that in early March 2020 R1 revealed to R1 FM 1 that they were left in a soiled diaper for 3 hours. It is alleged that R1 FM1 allegedly saw sores on R1. Interviews conducted with 6 out of 6 staff revealed that the facility has enough staff on schedule to meet the needs of the facility residents. Staff stated that there are 3 staff per shift and staff conduct rounds every two hours as well as respond to a resident request for a diaper change as needed. Staff indicated they have not received any concerns pertaining to incontinence care/changing of soiled diapers or any resident sustaining sores due to being left in a soiled diaper for 3 hours. Interviews conducted with 12 out of 13 residents revealed that the facility has enough staff on schedule and that facility staff meet their needs, 1 resident stated that there should be more staff on schedule and R1 is no longer a resident of the facility. 13 out of 13 residents stated that staff respond quickly if they need assistance. 11 out of 13 residents stated that staff conduct rounds and check in on residents every 2 hours. 1 resident stated that they do not know how often staff conduct rounds and 1 resident stated that staff do not conduct rounds in a timely manner. LPA was not able to get in contact with R1 F1-2. LPA reviewed Resident Rounds Sheets for July 2020 and observed that staff conduct adequate rounds which occur approximately every 2 hours. Interviewed residents did not have any concerns. Based on interviews conducted with facility staff, facility residents, and LPA record review, there was not enough supportive evidence to concur with the reported allegation.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20200727134657

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198602098
	VISIT DATE: 12/12/2022

NARRATIVE

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For the allegation, Staff spoke inappropriately to resident, it is alleged that facility staff make inappropriate comments to facility residents (R1) and to resident's family members (R1 F1-2) about resident. Interviews conducted with 6 out of 6 staff revealed that the facility staff do not make inappropriate comments to facility residents and do not speak inappropriately to facility residents. Interviews conducted with 12 out of 13 residents revealed that the facility have not made inappropriate comments or spoken to them inappropriately. 1 resident stated that staff have disrespected and/ or treated them poorly but did not want to provide a name of the staff and ended the interview. R1 is no longer a resident of the facility. LPA was not able to get in contact with R1 F1-2. Interviewed residents did not have any concerns. Based on interviews conducted with facility staff, and facility residents, there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Staff is not serving food of the quality or quantity to meet resident's needs, it is alleged that the facility only serves items such as plain peanut butter sandwiches or peanut better and jelly sandwiches and tea and facility is not provide adequate food items for residents that have to follow a special diet. Interviews conducted with 1 out of 13 residents stated that they follow a special diet and the facility does provide them with alternate meals. 1 resident did not want to continue their interview, 3 residents stated that the food could be better and 9 residents stated that they are satisfied with the food service, the food that is served is healthy and well balanced and they are served three meals a day which consist of a variety of foods. Interviews with 6 out of 6 staff revealed if any resident follows a special diet they are provided with modified diets. LPA reviewed the food menu and toured the kitchen and observed a healthy selection of foods. LPA also observed facility's food storage and observed sufficient food for 2 days worth of perishables and 7 days worth of non-perishables, which consisted of different meats, vegetables and fruits, breads, dairy, cereals, and variety of can foods. LPA reviewed 6 resident's Physician's Reports and 5 reports did not indicate that the resident's require a special diet. 1 Physician's Report did indicate that the resident requires a special diet, this report belongs to the resident that stated that the facility follows their diet. R1 is no longer a resident of the facility. LPA was not able to get in contact with R1 F1-2. Based on LPA observations, LPA review of facility menus, and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

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.

Facility has been closed as of 2/24/21. Reason for closure was change of ownership. Exit interview was not conducted, a hard copy of the Complaint Report will be mailed to Licensee Goldwater Sag Holdings, LLC (198602098) last known mailing address.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)981-3982
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2022

LIC9099 (FAS) - (06/04)

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