198602098-2-2-2023-28-AS-MVAO-CPAV3F-20230222150439

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 02/02/2023
Date Signed: 02/02/2023 05:45:48 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-20201125142633

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: 78	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Gil Agas, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff failed to properly dress a resident while in care.
Resident is wearing another resident's clothes while in care.
Staff failed to address residents laundry needs
Resident's room is not properly maintained
Staff fail to plan activities for residents
Staff mishandles a resident's personal belongings
Facility has inadequate record keeping
Resident are not being properly fed 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 regarding the above-mentioned allegations.

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) and resident#2’s (R2) records; interviewed staff #1 (S1), Licensee / Administrator; and virtually toured the facility. A subsequent visit was conducted on 12/20/22. During the visit, LPA interviewed staff#2 (R2), reviewed resident#1’s record, obtained resident roster, staff roster, and toured the facility. Another subsequent visit was conducted on 01/30/23. During the visit, LPA interviewed staff from staff #3 (S3) through staff #7 (S7), attempted to interview residents from resident#1 (R1) to resident#2 (R2), interviewed resident from resident #3 (R3) through resident #7 (R7), reviewed resident records of resident #1 (R1) and resident#2 (R2) and conducted a facility tour.
(-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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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-20201125142633

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: 02/02/2023

NARRATIVE

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On 02/02/23, today’s visit is another subsequent visit at the facility. During the visit, LPA reviewed additional residents’ files, conducted a facility tour and delivered findings.
The investigation revealed the following:
In regard of allegation, “staff failed to properly dress a resident while in care,” it was alleged that resident#1 was not dressed properly going to dialysis center and resident’s clothes were dirty. LPA interviewed a total of seven (7) residents. Five (5) out of seven (7) residents, which including two (2) residents who go to dialysis center, stated they were dressed properly whether going out in the community or at the facility and their clothes were clean. LPA attempted multiple times but failed to interview resident#1 and resident#2 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 had a regular laundry schedule to wash residents’ clothes. Staff would check on residents to make sure they were dress properly. LPA observed residents at the lobby and in their rooms, and found they looked clean and properly dressed. Thus, staff did not fail to clothes resident properly while in care.

In regard of allegation, “resident is wearing another resident's clothes while in care,” it was alleged that resident#1 was wearing other residents’ clothes. Per residents’ interviews, five (5) out of seven (7) residents stated they did not wear other residents’ clothes and they got their clothes back after laundry. LPA attempted multiple times but failed to interview resident#1 and resident#2 due to the loss of contact after they moved out. Seven (7) out of seven (7) staff interviewed denied the allegation. LPA observed residents at the lobby and in their rooms, and found their clothes looked clean. Therefore, resident is wearing resident’s own clothes while in care.

In regard of allegation, “staff failed to address residents’ laundry needs,” it was alleged that resident#1’s clothes were soiled. Per residents’ interviews, five (5) out of seven (7) residents stated they had laundry staff came to pick up laundry at least once or twice a week. They had clean clothes to change. LPA attempted multiple times but failed to interview resident#1 and resident#2 due to the loss of contact after they moved out. Seven (7) out of seven (7) staff interviewed denied the allegation. LPA observed residents’ clothes and laundry room at the facility. LPA observed residents had clean clothes in their closet, laundry room was operating and staff were working on residents’ laundry. Therefore, staff provided residents’ laundry needs at the facility.
(-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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201125142633

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: 02/02/2023

NARRATIVE

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In regard of allegation, “resident's room is not properly maintained, it was alleged that resident#1’s personal refrigerator, floor carpet, and room were dirty. LPA interviewed seven (7) residents. Five (5) out of seven (7) residents stated their rooms were clean at least once daily. They said their rooms and carpet were clean. LPA attempted multiple times but failed to interview resident#1 and resident#2 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 had a regular housekeeping schedule to keep up residents’ room. Staff would check on residents to make sure their rooms were clean. LPA observed residents’ rooms to be cleaned and carpet did not observe any stains. Thus, staff maintained residents’ room properly.

In regard of allegation, “staff fail to plan activities for residents,” it was alleged facility did not provide activities due to COVID 19. 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 limiting activities during the lockdown period. Department of Public Health issued a clearance letter on 11/19/2020. Therefore, facility did not fail to plan activities to residents.

In regard of allegation, “Staff mishandles a resident's personal belongings,” it was alleged that resident#1 had a personal television and many personal items missing. Five (5) out of seven (7) residents stated they were not aware of their personal items missing. LPA attempted multiple times but failed to interview resident#1 and resident#2 due to the loss of contact after they moved out. Seven (7) out of seven (7) staff interviewed denied the allegation. Administrator stated resident#1’s was unable to identify what personal items were missing upon moved out. Facility issued a check of $185 to resident #1 to compensate her said unidentifiable missing items upon discharge of the facility. Thus, staff did not mishandle a resident's personal belongings.

In regard of allegation, “facility has inadequate record keeping,” it was alleged that resident#1’s inventory list was not complete and updated. Five (5) out of seven (7) residents stated they did not corroborate the allegation. LPA attempted multiple times but failed to interview resident#1 and resident#2 due to the loss of contact after they moved out. Seven (7) out of seven (7) staff interviewed denied the allegation. Administrator stated resident#1’s was unable to identify what personal items were in resident’s procession. Per record review, Administrator attempted to update resident’s record, however, resident#1 and resident’s family was unable to identify what personal items were in resident’s procession or to notify facility if resident had any change on personal belongings. (-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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20201125142633

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: 02/02/2023

NARRATIVE

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Facility issued a check to resident#1 upon resident’s discharge to compensate any loss of resident’s belonging. Thus, staff did not fail to keep resident’s personal belonging record.

In regard of allegation, “resident is not being properly fed while in care,” it was alleged that staff did not serve resident#1 with adequate portions of food. LPA interviewed residents and five (5) out of seven (7) residents stated they got enough food to eat and fed properly. LPA attempted multiple times but failed to interview resident#1 and resident#2 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 facility had a certified dietitian to decide the dietary menu. Per record review, staff would follow dietitian menu when preparing dietary menu and serving food. LPA toured the kitchen and observed staff would use different measuring scoops to measure food portions when serving food to residents. A list of special diet residents was posted at the kitchen to notify staff. Thus, staff did not fail to feed resident properly 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 allegation 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 is 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: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC9099 (FAS) - (06/04)

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