<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 06/19/2025
Date Signed: 06/19/2025 02:32:36 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
06/17/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250617131216
FACILITY NAME:ARCADIA RETIREMENT VILLAGEFACILITY NUMBER:
198603401
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE RDTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 71DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Virgilio Agas/S-1TIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not administer medications to a resident in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegation. LPA met with Virgilio Agas (S-1) and discussed the purpose of today’s visit.

During this investigation, LPA obtained a copy of the staff and resident rosters, interviewed Staff #1 (S-1) through Staff #4 (S-4), reviewed R-1’s file and obtained relevant documentation, reviewed R-1’s medication and interviewed Resident #2 (R-2) through Resident #6 (R-6). LPA left messages for R-1 for a return phone call.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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 2
Control Number 28-AS-20250617131216
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: 06/19/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff did not administer medications to a resident in care. It has been alleged that staff are not refilling residents’ medication in a timely manner and that staff are calling resident a “drug addict”. Staff interviews revealed that residents’ medications are refilled in a timely manner. Interviewed staff indicated that medication administration is documented via the Medication Administration Record (MAR). Interviewed staff indicated that they have not had any issues refilling medication (including medication for R-1) and that R-1 is provided with medication as prescribed (including medication for sleep). Interviewed staff indicated that they have not witnessed nor received any concerns/complaints pertaining to this matter. Interviewed staff indicated that staff do not call any residents (including R-1) a “drug addict”. (5) out of (6) resident interviews revealed that residents receive their medication (including refills) in a timely manner. (5) out of (6) residents interviews indicated that they have not heard anyone complaining nor have any concerns pertaining to this matter. (5) out of (6) resident interviews indicated that staff do not call them “drug addicts”. Interviews and reviewed documentation do not corroborate this allegation.

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. LPA was experiencing technical difficulties during this visit. Therefore, a copy of the report and appeal rights will be sent via email to Virgilio Agas (S-1).

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2