198602098-1-30-2021-28-AS-MVAO-BZDVXV-20210323165010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 01/29/2021
Date Signed: 01/30/2021 01:10:37 PM

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
03/19/2020 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200319135949

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: 64	DATE:	01/29/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lourdes Garcia		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff refusing to give resident medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Lourdes Garcia (Facility Administrator). The initial 10-day investigation was conducted on 03/26/20 by LPA Irra and 04/01/20 by LPA Flores both of which required further investigation.

On 03/26/20, at approximately 1:45 P.M, LPA Irra conducted a telephone interview with the Facility Administrator. LPA requested copies of: Staff Roster, Resident Roster. For Residents R-1 through R-3 (R-1 through R-3): face sheet with contact information/phone numbers, Appraisal Needs and Services Plan (Current), MARs for February 2020 and March 2020 including any PRNs, Any notes on medication requests (regular vs PRN) and Physicians Report (Current). For Staff: Staff schedule for March 2020 (including Med Techs), Copy of Staff contact numbers (including Med Techs) and Copy of Staff training on Medication Administration. ***Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

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-20200319135949

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: 01/29/2021

NARRATIVE

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On 04/01/20, Staff #1 through Staff #3 (S-1 through S-3) and Resident #1 through Resident #6 (R-1 though R-6) were interviewed.

During today’s investigation, the Activity Director, Staff #4 through Staff #6 (S-4 through S-6) and were interviewed.

Allegation: Staff refusing to give resident medication.

During this investigation, the Facility Administrator, Staff #1 through Staff #7 (S-1 through S-6), Activity Director and Residents 1 through Resident 6 (R-1 through R-6) were interviewed. Interviewed staff indicated residents receive their medication as prescribed and in a timely manner. Interviewed staff indicated they have not received any concerns/complaints from other Residents nor staff pertaining to staff refusing to give residents medication. Interviewed staff also indicated they have not observed any staff yelling at residents. Five (5) out of the (6) interviewed Residents indicated that staff do not refuse to provide them with medication. (5) out of the (6) interviewed Residents indicated staff provide them with medication as prescribed and in a timely matter. Interviewed Residents indicated that they have not observed staff yelling at residents. Staff interviews and Resident interviews do not corroborate this 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.

A telephonic exit interview was conducted with the Facility Administrator, a hard copy was provided via e-mail for signature and Appeal Rights were provided

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021

LIC9099 (FAS) - (06/04)

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