198603401-5-22-2025-28-AS-WSHO-DH36L9-20250526205356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 05/22/2025
Date Signed: 05/22/2025 02:45:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/15/2025 and conducted by Evaluator Mayra Cota

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250515140937

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:	05/22/2025
		UNANNOUNCED	TIME BEGAN:	08:03 AM
MET WITH:	Virgilio Agas, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not ensure resident is accorded privacy.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced complaint visit regarding the above allegation. LPA met with Virgilio Agas, Administrator and the reason for the visit was explained.

The investigation consisted of the following: LPA, toured the common areas of the facility, obtained copies of staff and resident rosters and conducted interviews with Staff 1 - Staff 8 (S1-S8) and Resident 1 - Resident 10 (R1-R10).

Regarding: Staff did not ensure resident is accorded privacy.

It is alleged that staff entered a resident's room without permission while taking a shower, after resident asked staff to wait because they were nude.

***Continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

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-20250515140937

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198603401
	VISIT DATE: 05/22/2025

NARRATIVE

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The investigation revealed the following:
Eight (8) out of (8) staff deny the allegation. Interviews with staff indicated, residents are accorded privacy when staff need to access resident rooms to help with care and meetings their needs. Staff stated, facility follows protocols which require them to knock several times and announce themselves to residents before entering their rooms. Staff stated, they will not enter a room, unless they have permission from residents to do so. Staff further indicated, when resident's deny entry to their rooms, staff will wait until residents are ready to be visited by staff. In case there is a health concern and a resident needs to be checked on immediately, staff will inform Administrator and med-techs to assist in entering resident's room to do a wellness check. Interview with S3 indicated, due to R1 pressing their Life Alert pendant, S3 deemed it necessary to enter R1's room to check on R1 for possible medical emergency because R1 did not initially responded to S3's request to enter R1's room.
Nine (9) out of ten (10) interviews with residents indicated, staff are respectful of their privacy and conduct visits into their rooms when given permission to do so. Residents stated, staff knock on their doors, identify who they are and inform of the purpose of the room visit before entering their rooms. Nine (9) our of ten (10) residents have no concerns regarding privacy.
At the time of visit, LPA observed caregivers, housekeeping staff and other visitors providing privacy to residents by getting permission from residents before entering their rooms.

Based on observations, interviews conducted with staff and residents, the findings indicate, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Virgilio Agas, Administrator, and copy of the report was provided during visit.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025

LIC9099 (FAS) - (06/04)

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