198603401-5-20-2025-28-AS-RORN-DGWQQ6-20250522122150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 05/20/2025
Date Signed: 05/20/2025 03:26:04 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
05/12/2025 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250512153204

FACILITY NAME:	ARCADIA RETIREMENT VILLAGE		FACILITY NUMBER:	198603401
ADMINISTRATOR:	VIRGILIO AGAS		FACILITY TYPE:	740
ADDRESS:	607 WEST DUARTE RD		TELEPHONE:	(626) 447-6070
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	200	CENSUS: 72	DATE:	05/20/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Virgilio Agas		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff do not ensure that resident's incontinence needs are met
Staff do not prevent resident from developing pressure injuries while in care
Staff do not answer resident's call button in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted a complaint investigation at the facility. Upon arrival, LPA met with Administrator Virgilio Agas and explained the purpose of the visit.
The purpose of the visit is to investigate the allegations listed above.
During today's visit, LPA obtained a copy of the Staff/Resident Roster.
File of Resident R1 was reviewed and Special Incident Report's SIR's, Pre-placement Appraisal, Physician's Report and Resident Hourly Log was submitted.
Resident Rooms 115, 212, and 240 was inspected and call button was pressed for assistance.
Interview was conducted with Administrator.
Interviews were conducted with Resident R1-R7 and Staff S1, Staff S2. and Staff S3.
Interviews were conducted with the Home Health Nurse and Wound Specialist telephonically.
In regards to the allegation Staff do not ensure that resident's incontinence needs are met, based on interviews conducted with Resident R1 who revealed that diaper changes have been better lately.
Resident's 4-7 stated that everything has gone smoothly and staff will check frequently for changes.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20250512153204

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: 198603401
	VISIT DATE: 05/20/2025

NARRATIVE

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Resident's R2 and R3 only heard about late response time for diaper changes. Said they don't use diapers.
Home Health Nurse stated that caregivers assisted her with Resident R1 regarding incontinence care.
Stated they came within 5 minutes. Said it is Stage 2 wound and it is on and off with healing, Said they were not getting worse and wound was not declining.
Wound specialist stated that there was no moisture from urine and no redness and this shows no neglect by facility.
Staff stated that they do an hourly resident check and document it. Stated Resident R1 leaves the facility frequently and sometimes is not there when changes are to be done.
Resident One Hour Check 04/24/25 noted from 11 PM to 12 AM Resident R1 was outside in parking lot and was put in the bedroom.
On 05/07/25 changed Resident R1 and put her to bed.
On 05/16/25 4:00 AM staff helped give assistance to Resident R1 who was being uncooperative.
05/19/25 1:00 AM to 2:00 AM staff went to parking then to bedroom with Resident R1 and changed the diaper.
Based on record review and interviews conducted, the findings indicate, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Staff do not prevent resident from developing pressure injuries while in care, based on interviews conducted and information gathered Home Health Nurse stated that she felt wounds did not decline and felt facility was providing good care.
Wound specialist stated that there was no moisture from urine and no redness and this shows no neglect by facility.
Staff stated that they do an hourly resident check and document it. Stated Resident R1 leaves the facility frequently and sometimes is not there when changes are to be done.
Hourly checks done on 05/07/25 changed Resident R1 and put her to bed.
On 05/16/25 4:00 AM helped give assistance to Resident R1 who was being uncooperative.
05/19/25 1:00 AM to 2:00 AM staff went to parking then to bedroom and changed the diaper.
Resident's 2-7 stated that they do not have any pressure sores and staff assist others in a timely manner.
Based on record review and interviews conducted, the findings indicate, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250512153204

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: 198603401
	VISIT DATE: 05/20/2025

NARRATIVE

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In regards to the allegation Staff do not answer resident's call button in a timely manner, call button was pressed at today's visit in Rooms 115, 212 and 240 and staff responded immediately.
Staff stated that they will respond within 15 minutes and if they may be assisting other residents they will come back to them shortly.
Said if resident comes back to the facility late at night the front desk will page them to assist.
Resident One Hour Check notes on 05./16/25 at 12:00 AM a resident called and caregiver went to assist.
On 05/19/25 at 4:00 AM a resident called and caregiver came to assist in the restroom.
Resident 2-7 said they do not use the pull cord often, but when they have staff will come quickly.
Based on record review and interviews conducted, the findings indicate, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025

LIC9099 (FAS) - (06/04)

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