198602098-9-12-2023-28-AS-RORN-CVUMGT-20230920093629

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 09/12/2023
Date Signed: 09/12/2023 05:46:22 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
02/24/2021 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20210224160858

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: 84	DATE:	09/12/2023
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Virgilio (Gil) Agas, administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff member filmed resident without permission.
Facility did not follow reporting requirements.
Resident was retaliated against for making complaint.
Resident was illegally evicted.

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.

On 03/04/21, LPA Tao conducted the initial investigation visit telephonically due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. LPA obtained staff roster, resident roster, Resident #1’s (R1) Physician report, R1’s Identification and Emergency information, and related documents. LPA interviewed staff and residents telephonically.

On 09/12/23, LPA Tao conducted a subsequent visit today. During the visit, LPA obtained copies of staff and resident rosters, interviewed residents from resident #3 (R3) through resident #9 (R9), reviewed resident #1 (R1) records, conducted a facility tour and delivered findings.

(-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: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

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-20210224160858

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: 09/12/2023

NARRATIVE

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Investigation consisted of the following: interviews of staff from Staff#2 (S2) to Staff#6 (S6); interviews of residents from Resident#2 (R2) through Resident#9 (R9); attempted to interview Staff#1 (S1) and resident #1(R1); reviewed resident#1’s record reviews, and a facility tour.

In regard of the allegation, “staff member filmed resident without permission,” it was alleged that staff conducted a video recording of a resident without resident’s permission. The investigation revealed the following: LPA attempted to interview resident#1(R1), all attempts failed and unable to contact with R1. Eight (8) out of eight (8) residents interviewed could not corroborate the allegation. All five (5) staff interviewed denied the allegation. Both staff and resident interviews revealed that residents were not aware of staff who had filmed residents without permission at the facility. LPA reviewed the video footage and observed Staff#3 (R3) conducted video recording on R1 while approaching and intervening the residents because R1 was hitting R2 in the hallway. The video recording took place in a hallway which was facility's common/public area. Staff had notified R1 that staff would do video recording to record the incident at the spot. Therefore, staff recorded video footage in the hallway to record an incident and had notified resident about the recording.

In regard of the allegation, “facility did not follow reporting requirements,” it was alleged that facility failed to report incident to Licensing. The investigation revealed the following: LPA attempted but failed to interview resident#1(R1). Eight (8) out of eight (8) residents interviewed could not corroborate the allegation. All five (5) staff interviewed denied the allegation. Per file review, an incident report, dated 2/4/21, was filed to Licensing. It detailed the incident regarding R1 which was happened on 2/4/21. Therefore, facility had followed reporting requirements.

In regard of the allegation, “resident was retaliated against for making complaint,” it was alleged that staff retaliated resident after filed a complaint. The investigation revealed the following: LPA attempted but failed to interview resident#1(R1). Eight (8) out of eight (8) residents interviewed could not corroborate the allegation. Per residents’ interviews, included resident who had filed complaint again the facility, revealed staff did not retaliate against residents for making complaint. All five (5) staff interviewed denied the allegation. Staff interviews revealed residents had resident’s right to file complaint. Therefore, there is not preponderance evidence to prove resident was retaliated against for making complaint.

(-continued in LIC 9099 C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210224160858

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: 09/12/2023

NARRATIVE

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In regard of the allegation, “resident was illegally evicted,” it was alleged that staff evicted resident illegally. The investigation revealed the following: LPA attempted to interview resident#1(R1), all attempts failed. Eight (8) out of eight (8) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents were not aware of any illegal eviction taking place at the facility. All five (5) staff interviewed denied the allegation. Per record review, resident#1 was relocated to another facility. That relocation was approved by a program manager from Los Angeles Department of Health Care Services (DHS) because resident was not compatible staying at an assisted living facility and needed a higher level of care. Therefore, it was not an eviction, but a relocation approved by DHS from LA county.

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

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Administrator, Gil Agas. 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: 09/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023

LIC9099 (FAS) - (06/04)

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