198602098-4-8-2021-28-AS-MVAO-C23PHZ-20210414112045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 04/08/2021
Date Signed: 04/08/2021 05:19:34 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
09/24/2019 and conducted by Evaluator Joe Katrdzhyan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20190924115620

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: 60	DATE:	04/08/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator / Gil Agas		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Management is not available for assistance.

Staff schedule is not accurate.

Signal system is not being monitored.

Residents are not getting their showers.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joe Katrdzhyan initiated a follow up 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 Administrator / Gil Agas.

LPA Katrdzhyan conducted the initial complaint visit to this facility on 9/30/19. During the course of this investigation, LPA Katrdzhyan conducted telephone interviews with the former Administrator / Lourdes Garcia, current Administrator / Gil Agas, Staff members 1 through 4 (S1 - S4) and Residents 1 through 5 (R1 - R5). Also, copies of the following documents were obtained and reviewed;
• Current Resident Roster • LIC 500 / Personnel Report • Weekly shower schedule

The investigation revealed the following;
Allegation: Management is not available for assistance. The details of this allegation state that the former

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021

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-20190924115620

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: 04/08/2021

NARRATIVE

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Administrator took time off due to a sore foot and there was no one designated in her place to assist the residents. According to former Administrator / Lourdes Garcia, during the time she fractured her left leg, the Assistant Administrator / Mary Salcedo was the designated person in charge of the facility. Ms. Garcia only missed a few days and continued working at the facility even though she was on crutches and her left leg was in a boot. A few moths after, Ms. Salcedo left the facility for personal reasons and Gemma Deoso was the newly assigned person in charge of the facility. Based on interviews conducted, the statements obtained were consistent in stating that the facility had a designated person in charge to assist with the residents needs whenever the former Administrator missed time from work. There is insufficient evidence to support the allegation of "Management is not available for assistance".

Allegation: Staff schedule is not accurate. During the course of this investigation, LPA obtained a copy of the Personnel Report and verified the staff schedule with Administrator / Gil Agas to be accurate. LPA learned that the staff schedule may not be reflect the correct schedule at times as a result of staff calling in sick last minute and management having to find coverage. Staff also make changes to the schedule by switching shifts with co-workers in the event they need to take a day off. For the most part, staff follow their schedules and there are no issues. Statements obtained from staff were consistent indicating staff follow their work schedules and there are no issues. Based on the interviews conducted and record reviews, there is insufficient evidence to support the allegation of "Staff schedule is not accurate".

Allegation: Signal system is not being monitored. The details of this allegation state that there is no one at the desk monitoring the signal system for two hours in the morning due to facility being short staffed. Based on interviews conducted and record reviews, the statements obtained were inconsistent with this allegation. LPA learned that the front desk staff normally start their shift at 7AM and end at 8PM. Staff carry a telephone with them to answer calls and respond to resident needs after 8PM and before 7AM. Based on interviews conducted, LPA learned that the facility has sufficient staff to meet the needs of residents as there are at least 2 caregivers and 1 med tech working the graveyard shift from 10:30PM - 6:30AM. Based on the interviews conducted and record reviews, there is insufficient evidence to support the allegation of "Signal system is not being monitored".

Allegation: Residents are not getting their showers. During the course of this investigation, LPA obtained a copy of the resident shower schedule and verified with staff and residents that residents are getting their showers regularly on their scheduled days. LPA learned that in the event a resident refuses to shower on

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20190924115620

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: 04/08/2021

NARRATIVE

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their scheduled date, Staff obtain a document from the resident(s) stating their refusal and arrangements are made to schedule the shower on the following day. Based on interviews conducted and record reviews, the statements obtained were inconsistent with this allegation. There is insufficient evidence to support the allegation of "Residents are not getting their showers".

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

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

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021

LIC9099 (FAS) - (06/04)

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