198602098-5-10-2021-28-AS-MVAO-C3ZRNW-20210615131059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602098
Report Date: 05/10/2021
Date Signed: 05/10/2021 04:38:27 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
09/10/2020 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200910111921

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: 64	DATE:	05/10/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Virgilio Agas		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Residents are not afforded privacy while in care
Staff yelled at resident
Staff inappropriately pushed resident while in care
Staff did not provide for privacy during phone call and interrupted resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Spencer conducted a subsequent visit to deliver the findings for the allegations listed above. LPA Spencer met with administrator Virgilio Agas and explained the purpose of today's visit.
LPA Miramontes conducted the initial 10-day investigation. LPA Spencer conducted the subsequent visit and requested a copy of the staff roster, resident roster, incident report regarding resident #1 (R1), and police report. LPA Spencer interviewed the administrator, staff #1 (S1), staff #2 (S2), and residents #1-7 (R1-R7). R7 could not complete interviews because the resident passed away so 6 resident interviews were completed.
The investigation revealed the following: Regarding the allegation that residents are not afforded privacy while in care, all staff stated that they knock before entering a resident's room and ask if they can come in. The administrator stated that if residents do not want the staff to come in, the staff will not enter and notate that the resident refused care. The staff stated that residents are always provided with privacy. R2-R5 stated that staff always knock and announce themselves before entering the room. *Continued on LIC9099C.

Unsubstantiated

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: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

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-20200910111921

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: 05/10/2021

NARRATIVE

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R1 and R6 stated that the staff used to briefly knock and enter but now they knock and wait for a response.
Staff yelled at resident
It was alleged that S1 yelled at R1 during an incident on 9/2/20. The administrator stated that he was unsure because he did not witness the incident and S1-S2 denied that staff yelled at R1. R2-R5 said that staff never yell and always treat them with respect, while R6 said that staff sometimes yell but not often. R1 stated that staff did not yell at her during the incident but S1's body language was threatening when she entered the room and slammed down the food tray. LPA reviewed the police report which did not mention that yelling was reported.
Staff inappropriately pushed resident while in care
It was alleged that S1 pushed R1 during an incident on 9/20/20. The administrator stated that R1 has a history of outbursts and verbal and physical aggression towards staff, but denied that staff pushed the resident. S1 denied that she pushed R1 but stated that the resident assaulted her and she immediately called for help. S2 stated that during the incident S1 called her asking for help because R1 attacked her and she needed assistance. When S2 came she saw that S1 was in the hallway and R1 was in her room appearing very upset. S2 said that S1 told her that R1 did not want the food tray in that area and that's why she got upset. R1 stated that S1 got defensive and pushed her during the argument. R2, R3, R4, and R6 stated that staff have never pushed them or heard of any resident being pushed by staff. R5 stated that a staff pushed her and she pushed back but did not provide further details. LPA reviewed the police report and it mentioned that an employee called because a resident repeatedly hit them. It did not mention that staff hit the resident. A review of the incident report stated that R1 threw the food tray and started attacking S1, resulting in bruising of staff's arm. The facility provided photo of bruising which showed mild discoloration on the palm and wrist area of S1's right arm.
Staff did not provide for privacy during phone call and interrupted resident
When interviewed, all staff stated that the facility has a cell phone that residents can use for private calls. They stated that residents can take the cell phone to the library or up to their room and there is no time limit. Staff stated that they have not heard of residents complaining about privacy during phone calls. R1 stated staff have interrupted her calls many times and that she is rushed off the phone. R2-R5 stated that they have personal cell phones but they have been able to use the facility phone when needed with privacy. R6 stated that staff sometimes interrupt and asked him to end the call. 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. An exit interview and a copy of the report was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021

LIC9099 (FAS) - (06/04)

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