198602098-2-17-2021-28-AS-MVAO-BZMN7V-20210331101322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 02/17/2021
Date Signed: 02/17/2021 12:21:13 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
10/20/2020 and conducted by Evaluator Tony Vasallo

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201020141846

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: 81	DATE:	02/17/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Gil Agas, assistant administrator		TIME COMPLETED:	12:25 PM

ALLEGATION(S):

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Facility staff fail to communicate with residents' responsible party
Facility staff fail to facilitate communication between residents and the Ombudsman

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vasallo initiated a subsequent 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 Gil Agas, assistant administrator. The initial complaint visit was conducted on 10/27/20.

The investigation consisted of the following: Interviews were conducted with facility staff including medication technicians (Med Tech), administrator, and assistant administrator. Interviews were also conducted with residents’ family members/responsible parties. LPA also obtained a resident and staff roster, and responsible parties contact information.

The investigation revealed the following: Allegation - Facility staff fail to communicate with residents' responsible party. LPA was able to communicate with 8 residents’ family members/responsible parties. Family members were interviewed on 11/2/20 via telephone. Continued on 9099C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

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-20201020141846

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: 02/17/2021

NARRATIVE

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8 out of the 5 family members interviewed indicated they were not notified by the facility that there were COVID-19 positive cases at the facility. Administrator was interviewed and indicated that many of the families were contacted and notified of the cases. However, administrator was not tracking the phone calls made and said it was possible some of the families were not notified. This allegation is substantiated.

Allegation - Facility staff fail to facilitate communication between residents and the Ombudsman. It’s alleged that the Ombudsman has attempted to contact the administrator on 10/6/20, 10/7/20, and 10/9/20 with no success. Allegedly the Ombudsman also emailed the administrator on 10/15/20 and did not get a response. Administrator was interviewed and she indicated that it was hard to keep track of all the agencies to contact because of COVID-19. When administrator was asked how long it has taken to call the Ombudsman back administrator indicated she wasn’t sure. Title 22 Regulations indicate residents have the right to visitors including the Ombudsman during reasonable hours and without prior notice. Due to COVID-19, the Ombudsman was conducting tele-visits and interviews. This allegation is substantiated.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D.

A telephonic exit interview was conducted with Gil Agas, and a hard copy was provided via email for signature along with appeal rights.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201020141846

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/24/2021 Section Cited CCR 87468.1(a)(8)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including on going evaluations.....	1 2 3 4 5 6 7	Assistant administrator indicated he is now emailing all the residents and residents' responsible parties. This plan will be submitted as a POC by 2/24/21.
	8 9 10 11 12 13 14	This deficiency was evidenced by the following: Interviews conducted with family members and or responsible parties confirmed they were not being notified of positive COVID-19 cases in the facility.	8 9 10 11 12 13 14
Type B 02/24/2021 Section Cited CCR 87468.1(a)(11)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities:(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice.....	1 2 3 4 5 6 7	Assistant administrator indicated he is now emailing the Ombudsman and is conducting FaceTime calls with the Ombudsman so interviews can be conducted with residents. This plan will be submitted as a POC by 2/24/21.
	8 9 10 11 12 13 14	This deficiency was evidenced by the following: The Ombudsman attempted to contact administrator on 10/6/20, 10/7/20, and 10/9/20 to schedule interviews with residents. Ombudsman did not receive a call back from administrator. Therefore, Ombudsman was not able to conduct interviews.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

LIC9099 (FAS) - (06/04)

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