198602098-2-24-2023-28-AS-MVAO-CPJQBN-20230302110148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 02/24/2023
Date Signed: 02/24/2023 12:36:44 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
11/25/2020 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20201125145216

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: 79	DATE:	02/24/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Virgilio Agas, administrator		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Resident is not being provided appropriate medical services while in care.
Resident's pressure dressing was not properly addressed while in care.
Resident is unable to communicate with a relative.
Residents are being isolated to their rooms while in care.
Staff failed to address a resident's hygiene needs.
Staff failed to keep the facility free from pests.
Staff is limiting a resident from using their walker while in care.
Resident is not being provided services as noted while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced complaint investigation for the allegations listed above today. LPA met Administrator, Gil Agas and explained the purpose of today's visit.

This complaint is a continuation of complaint control Number: 28-AS-20201125142633.

The investigation consist of the following:
The initial investigation visit was conducted telephonically on 12/07/2020 due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. LPA Tao obtained staff roster, resident roster, resident#1’s (R1) records, resident#2’s (R2) records, and incident reports of R1 and R2; interviewed staff #1 (S1), Licensee / Administrator; and virtually toured the facility.

(-continued in LIC9099C-)

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: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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 4

Control Number 28-AS-20201125145216

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: 02/24/2023

NARRATIVE

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On 02/16/23, a subsequent investigation visit at the facility was conducted. LPA interviewed staff from staff#3 (R3) to staff#7 (R7); interviewed residents from resident#3 (R3) to resident#7 (R7); attempted to interview resident#1 (R1) and resident#2 (R2); reviewed resident#1’s records; obtained resident roster and staff roster; and toured the facility.

Today, 02/24/23, a second subsequent investigation visit was conducted. During the visit, LPA interviewed staff #2 (S2), obtained resident roster and staff roster, and conducted a facility tour.

The investigation revealed the following:
In regard of allegation, “resident is not being provided appropriate medical services while in care,” it was alleged that resident#2 was not provided with proper medication. LPA interviewed a total of seven (7) residents. Five (5) out of seven (7) residents stated their medication was administered appropriately as prescribed. LPA attempted multiple times but failed to interview resident#1 (R1) and resident#2 (R2) due to the loss of contact after they moved out. Seven (7) out of seven (7) staff interviewed denied the allegation. Staff interviews revealed that staff followed doctors’ prescriptions to provide medication to residents. Per file review of a doctor prescription dated 06/17/2019, staff administered medication to resident#2 (R2) per R2’s doctor prescription. Thus, staff did not fail to provide medical services to resident while in care.

In regard of allegation, “resident's pressure dressing was not properly addressed while in care”, it was alleged that resident#1 (R1)’s pressure dressing was not being removed promptly by facility staff which causing potential damage to dialysis access site. LPA interviewed seven (7) residents. Based on residents’ interviews, five (5) out of seven (7) residents, including two (2) residents who would go to dialysis center regularly, could not corroborate the allegation. LPA attempted multiple times but failed to interview resident#1 (R1) and resident#2 (R2) due to the loss of contact after they moved out. Seven (7) out of seven (7) staff interviewed denied the allegation. Therefore, there was not preponderance of evidence to show staff improperly handle resident’s pressure dressing.

In regard of allegation, “Resident is unable to communicate with a relative,” it was alleged that resident#1 (R1)’s daughter was unable to reach R1 via cell phone calls for over a week due to R1’s cell phone was not being charged by staff as R1’s daughter requested staff to charge R1’s phone.
(-continued in LIC9099C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201125145216

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: 02/24/2023

NARRATIVE

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Per residents’ interviews, five (5) out of seven (7) residents stated they were able to communicate with families and any individuals that residents wanted to contact. As stated above, LPA was unable to interview resident#1 and resident#2. Seven (7) out of seven (7) staff interviewed denied the allegation. LPA tested the landline phone at the facility and it was operable. Most residents at the facility had their own cell phones besides the landline phone. Therefore, residents were able to communicate with families and friends.

In regard of allegation, “residents are being isolated to their rooms while in care,” it was alleged that residents were kept in room all day due to COVID -19 outbreak at the facility. LPA interviewed seven (7) residents. Five (5) out of seven (7) residents stated they were stayed in their room quarantined during the COVID -19 outbreak back in 2020. As stated above, LPA was unable to interview resident#1 and resident#2. Seven (7) out of seven (7) staff interviewed denied the allegation. Per record review, facility was under a locked down period from 10/29/2020 to 11/19/2020 due to Coronavirus Disease 2019 (COVID-19) positive cases. Facility must follow COVID 19 protocol on having residents quarantined in their rooms during the lock down period. Department of Public Health (DPH) issued a clearance letter on 11/19/2020 to clear and reopen the facility. Therefore, residents were quarantined, not isolated, in their room during COVID lock down period per DPH’s directives.

In regard of allegation, “staff failed to address a resident's hygiene needs,” it was alleged that Resident#1 (R1) wore dirty clothes and no personal care items were applied on R1. Per residents’ interviews, five (5) out of seven (7) residents stated they had clean clothes to change and had personal care supplies for their uses by themselves or with staff assistance. As stated above, LPA was unable to interview resident#1 and resident#2. Seven (7) out of seven (7) staff interviewed denied the allegation. LPA observed residents to be clean and neat. Residents’ closet had clean clothes and personal hygiene supplies were observed during interview. Therefore, staff did not fail to address residents’ hygiene needs

In regard of allegation, “staff failed to keep the facility free from pests,” it was alleged that resident#1 (R1)’s daughter who claimed to have seen a live cockroach in the facility kitchen and dead ants in R1’s bathroom. Five (5) out of seven (7) residents stated they were not allowed to enter facility kitchen, did not see live cockroach and did not see dead ants in their rooms. LPA was unable to interview resident#1 and resident#2. Seven (7) out of seven (7) staff interviewed denied the allegation.
(-continued in LIC 9099C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 28-AS-20201125145216

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: 02/24/2023

NARRATIVE

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On the virtual tour, dated 12/07/2020 and facility tour, dated 02/16/23, LPA did not observe live cockroach in the kitchen or dead ants in residents’ room. Thus, there was not preponderance of evidence to show staff fail to keep the facility free from pests.

In regard of allegation, “staff is limiting a resident from using their walker while in care,” it was alleged that resident#1 (R1)’s walker was moved away from R1 and stored in closet due to staff felt R1’s use of walker was a fall risk. Five (5) out of seven (7) residents could not corroborate the allegation. LPA was unable to interview resident#1 and resident#2. Seven (7) out of seven (7) staff interviewed denied the allegation. Per file review of R1’s physician report, R1 was non-ambulatory, not able to walk without physical assistance, required to use wheelchair and unable to use walker. Thus, resident#1’s use of walker should be limited due to R1 was unable to use walker.

In regard of allegation, “resident is not being provided services as noted while in care,” it was alleged that resident#1 (R1) had never been seen by facility physician at the facility. Five (5) out of seven (7) residents interviewed could not corroborate the allegation. LPA was unable to interview resident#1 and resident#2. Seven (7) out of seven (7) staff interviewed denied the allegation. Staff interviews revealed that facility physician had visit residents. Per record review, R1 stayed at the facility for about four (4) months while the facility was going through COVID lock down period, therefore, physician visit would be conducted telephonically. Thus, there was not preponderance of evidence to show staff fail to provide services as noted while in care.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Administrator, Gil Agas and findings were discussed. A copy this report was provided to Administrator at time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

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