198603401-4-7-2022-28-AS-MVAO-CDGRDY-20220414125643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 04/07/2022
Date Signed: 04/07/2022 06:26:24 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
04/01/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220401150146

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: 74	DATE:	04/07/2022
		UNANNOUNCED	TIME BEGAN:	11:32 AM
MET WITH:	Gil Agas, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff left resident in soiled clothing for a long period of time.
Staff called resident an inappropriate name.
Staff did not accompany resident to medical appointments.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPA) Tao, conducted unannounced complaint investigation for the allegations listed above today. During today’s visit, LPA was allowed entry by Administrator. LPA explained the purpose of today's visit regarding the above-mentioned allegations.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #6 (S6); interviews of residents from Resident#1 (R1) through Resident #7 (R7); reviewed resident#1’s record reviews, and a facility tour.

LPA obtained copies of the Staff and Resident Rosters; and resident files for Resident #1 (R1) with relevant information.

The investigation revealed the following: (-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

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-20220401150146

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: 04/07/2022

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

In regard to allegation: “Staff left resident in soiled clothing for a long period of time," it was alleged that staff refused to assist R1 with changing and caused R1 to be soiled head to toe. Six (6) out of seven (7) residents could not corroborate the allegation. Resident interviews from R2 through R7 revealed that staff did not refuse to assist residents with changing and left them in soiled clothing for an extended period of time. Staff would check on residents to ensure residents’ changing needs are met. Six (6) out of six (6) staff denied the allegation. Staff interviews revealed no staff refuse to assist residents changing clothes and cause residents to be soiled. File review revealed R1 refused staff to change him. LPA did not observe residents left in soiled clothing for an extended period of time during the visit.

In regard to allegation: “Staff called resident an inappropriate name,” it was alleged that staff call R1 with inappropriate name. Six (6) out of seven (7) residents could not corroborate the allegation. Resident interviews from R2 through R7 revealed that staff did not call residents with inappropriate name. Staff treat residents nicely. Six (6) out of six (6) staff denied the allegation. Staff interviews revealed no staff call residents with inappropriate name. LPA did not observe or hear staff call residents with inappropriate name during the visit.

In regard to allegation: “Staff did not accompany resident to medical appointments”, it was alleged that R1 was not able to see doctors as facility would not accompany resident to the visits. Six (6) out of seven (7) residents could not corroborate the allegation. Resident interviews from R2 through R7 revealed that staff would accompany and assist residents for their medical appointments. Staff would arrange transportation for residents when needed. Six (6) out of six (6) staff denied the allegation. Staff interviews revealed staff would assist and accompany residents to medical appointment. LPA interviewed administrator and stated that due to the time conflict of doctor available time and transportation access, resident’s medical appointment was rescheduled to another day. R1 was able to see doctors and staff accompanied resident to the appointment. Record review revealed that resident was able to see doctors.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, all three allegations are UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with Administrator. A hard copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2