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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 08/24/2025
Date Signed: 08/24/2025 09:59:41 AM

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
08/11/2025 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250811094019
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:
08/24/2025
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Med-Tech Jennifer ArroyoTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff using inappropriate forms of punishment.
Facility temperature valve is in disrepair.
Staff does not safeguard resident’s medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Med-Tech Jennifer Arroyo and explained the purpose of the visit. Administrator Virgilio Agas was notified by telephone.

The investigation consisted of the following: During the initial visit conducted on 08/18/2025, LPA interviewed Administrator and Resident (R1). LPA obtained copies of the following documents: staff roster, resident roster R1 ‘s emergency identification sheet, physicians report, and appraisal needs and service plan. LPA also checked six (6) resident bathroom, tested water pressure, and water temperature. During visit on 08/21/2025 LPA’s interviewed staff 1-staff 5 (S1-S5), and interviewed residents 2-residents 6 (R2-R6). During today’s visit LPA delivered findings.

See 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2025
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-20250811094019
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: 08/24/2025
NARRATIVE
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In regard to the allegation “Staff using inappropriate forms of punishment”, it is alleged that staff threatens residents with a 5150 hold and other forms of punishment. During interviews with Administrator and staff six (6) out of six (6) stated that they have never threatened residents with any form of punishment. Administrator stated they can’t just call on a 5150 hold that order comes from a doctor. During interviews with residents five (5) out of six (6) residents stated that they have never been threatened with any form of punishment nor have they ever heard any resident being threatened with a 5150 hold.

In regard to the allegation “Facility temperature valve is in disrepair.”, it is alleged that shower valves are in disrepair and water is too hot. During interviews with Administrator and staff six (6) out of six (6) stated that there have been no problems with water or shower valves. LPA checked six (6) shower valves and tested six (6) shower temperatures and found all valves in working condition and water within the required temperature of 105-120 Fahrenheit. During interviews with residents five (5) out of six (6) residents stated that they have had no issues with valves or water temperature in their showers.

In regard to the allegation “Staff does not safeguard resident’s medication”, it is alleged that medication is missing from resident’s bedroom. because staff leaves the master key laying around. During interviews with Administrator and staff six (6) out of six (6) stated that staff never leaves the key laying around. Administrator stated that staff won’t enter certain resident’s room without their consent because they don’t want to be accused of stealing During interviews with residents five (5) out of six (6) residents stated that they have never had anything missing from their rooms nor have they ever witnessed anyone entering their room with a master key that staff left lying around.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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 was conducted, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2