198602098-2-12-2021-28-AS-MVAO-BZMQH4-20210331121032

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 02/12/2021
Date Signed: 02/12/2021 05:01:34 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
07/29/2020 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200729125826

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: 71	DATE:	02/12/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Virgilio Agas, co-administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal property
Staff did not assist resident with showering
There are roaches in the facility
The facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicole Spencer 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 Virgilio Agas, the facility administrator.

The initial tele-visit was conducted on 8/7/20 and consisted of the following: LPA Spencer conducted telephone interviews with the co-administrator Virgilio Agas and Resident #1-3. A video Facetime call was conducted including a tour of the facility grounds and the LPA received copies of the requested documents: staff roster, resident roster, face sheet for resident #2, Needs and Services plan for resident #2, Admissions Agreement, pest control service agreement, staff contact information, copy of check payment for August rent for resident #2, and past due balance letter for resident #2. Additional staff and resident interviews were conducted during the investigation. The subsequent tele-visit to deliver findings was conducted on 2/12/21 with co-administrator Virgilio Agas. *See LIC 9099C for continuation of this report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

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-20200729125826

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: 02/12/2021

NARRATIVE

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The investigation revealed the following: Staff did not safeguard resident's personal property
The administrator Lourdes Garcia admitted that the facility does not keep a list of valuables or safeguarded property. When residents lose items, she stated that the staff look for it but do not replace it if not found. Co-administrator Vergilio Agas said that residents can keep their belongings in a safety box but they are responsible for it. During the visual inspection, it was observed that some residents had safety boxes but others did not. A total of 9 residents were interviewed. 7 out of 9 residents state that they have had missing items or have heard of other residents missing items. A total of 5 staff were interviewed. 2 out of 5 admitted that they have heard of residents complain of missing property.
Staff did not assist resident with showering
A review of the admissions agreement reveals that residents are to be provided with showering assistance based on their level of care needs and their scheduled shower days are logged on the shower log. A review of the shower log revealed that the majority residents are scheduled to be showered twice a week. A total of 9 residents were interviewed. 5 residents stated that they have not had showers according to their showering schedule, 3 residents stated that they shower independently, and 1 heard of other residents not being showered according to showering schedule. 3 staff stated that if residents miss their assigned shower that it will be rescheduled, while 2 did not know.
There are roaches in the facility
The virtual inspection of a resident room revealed that there were roaches in the bathroom of resident #2. A total of 9 residents were interviewed. 5 said that they have seen roaches, 2 says they have seen water bugs, and 2 stated that they have not seen any bugs at the facility. A total of 5 staff were interviewed. All 5 staff admitted that they have observed or heard of residents complain about roaches. The administrator stated that they try to spray once a month but admitted that they haven't come recently due to the pandemic. Interview with Stanley Pest Control revealed that the last time they serviced the facility was in 2018.
The facility is in disrepair
The virtual inspection of resident rooms revealed that blinds were in disrepair. The administrator admitted that blinds are in disrepair and the co-administrator stated that they are in the process of fixing the blinds. 3 additional staff also stated that residents have complained about blinds in disrepair. A total of 9 residents were interviewed. 6 out of 9 residents stated that they have blinds in disrepair.
Based on observations, interviews, and record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated.
Refer to the LIC 9099D for the citations issued. An exit interview, a copy of this report and Appeals Rights were provided to the facility co-administrator Virgilio Agas.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200729125826

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: 02/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/12/2021 Section Cited CCR 87217(b)	1 2 3 4 5 6 7	87217(b): Safeguards for Residents cash, Personal Property, and Valuables: Every facility shall...safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility will send out a letter to all residents asking them to update their personal property inventory. Facility will keep an accurate and updated log of resident's personal property and will submit copy of letter to CCL by 2/28/21.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not safeguard resident's personal property. 7 out of 9 residents interviewed stated that they have had or heard of residents missing property. This poses a potential risk to the personal rights of persons in care.	8 9 10 11 12 13 14
Type B 02/12/2021 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87646(f)(4): Basic Services: Basic services shall at a minimum include...personal assistance and care as needed by the resident...such as dressing, eating, bathing.This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The facility will maintain an accurate shower log and ensure that residents who require assistance with showering get showered on schedule. Will send shower log for week of 2/25-2/19 to CCL by 2/28/21.
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not ensure that residents were showered according to shower schedule. 6 out of 9 residents interviewed stated that they have not been showered on schedule which poses a potential risk to the health of persons in care.	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: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20200729125826

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: 02/12/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/12/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a): Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Install missing blinds for all resident rooms. Submit picture proof by 2/28/21.
	8 9 10 11 12 13 14	Based on observation and interview, the licensee did not ensure the facility was in good repair. The virtual inspection revealed disrepaired blinds in resident rooms. This poses a potential threat to the safety of persons in care.	8 9 10 11 12 13 14
Type B 02/12/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303(a): Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Facility Administrator shall contract the services of a pest control company to alleviate the roaches. Facility Administrator shall closely monitor the roach issue and have the pest control company treat the facility at least monthly and submit service agreement to LPA by 2/28/21.
	8 9 10 11 12 13 14	Based on observation and interviews, the licensee did not ensure the facility was kept clean and free of roaches. 5 out of 9 residents and 5 out of 5 staff stating that they have seen insects (roaches) in the facility.This poses a potential threat to the health of persons in care.	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: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2021

LIC9099 (FAS) - (06/04)

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