198603401-9-16-2025-28-AS-RORN-DQCNUX-20260115094701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 09/16/2025
Date Signed: 09/16/2025 03:48:43 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
09/09/2025 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250909133123

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: 70	DATE:	09/16/2025
		UNANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Administrator-Virgilio 'Gil' Agas		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not prevent other resident from entering another residents room.
Staff did not ensure residents personal property was safely secured.
Faciliy elevator is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid conducted 10-day unannounced complaint visit, was met by Receptionist Giselle Provencio, Gil Agas Administrator was notified and arrived shortly after and assisted with the facility tour.

The investigation consisted of the following: LPA Vaid requested, obtained and reviewed the staff/ residents’ roster. Face-sheet, physicians report, medications list, admissions agreement, IPPs and pre-appraisals for three (3) residents. Repair and service invoice for two (2) elevators. Arcadia Fire department inspection report. Facility visitors log. Toured the facility interviewed staff/residents. Did not observe any health and safety concerns.

The investigation revealed the following:

Continued on 9099C..................................

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

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-20250909133123

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: 09/16/2025

NARRATIVE

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Regarding the allegation: Staff did not prevent other resident from entering another resident’s room. It is alleged that the staff are not preventing residents from entering another resident’s room without their knowledge. Per the complaint two (2) Hispanics residents gained entry by stealing master key from caregiver and making copies and entered residents’ room without their knowledge and damaged residents’ personal property. Five (5) of five (5) staff interviewed denied this allegation. Six (6) of seven (7) residents interviewed could not corroborate this allegation. Staff interviewed stated they are not aware of the residents’ that visit other residents’ rooms. Staff stated they cannot prevent residents from visiting other residents and how the residents are granted entry to the other residents’ room, the assisted living facility staff cannot watch each resident on a 24 hours one to one basis. The facility does not have cameras in the facility. Staff cannot control who the residents befriend. Residents interviewed stated they are allowed entry to their friends’ room when they visit and vice versa. According to the Administrator no keys have been lost nor reported stolen, all master keys are accounted. According to the staff, each resident has keys to their rooms and are constantly reminded to lock their rooms and report their valuables to staff. Staff stated they have a master key used to enter residents’ rooms for housekeeping. Staff stated they make their presences known and will knock before entering resident’s room. The staff key is kept on the staff person when on duty making rounds. Staff stated they have never left their keys unattended in the presence of residents’. Neighboring rooms #200, and #205 are empty according to the resident roster and observations made by LPA Vaid since 2023, and resident in #203 is non-Hispanic. Visitor log dated 9/8/25 does not shown visitors with Hispanic names. Based upon interviews conducted the findings indicate that, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Staff did not ensure residents personal property was safely secured. It is alleged that staff are not ensuring residents’ personal property is secured and prevent from being tampered by the staff. Per the complaint facility has installed micro cameras in the smoke detectors to spy on residents. Five (5) of five (5) staff interviewed denied this allegation. Six (6) of seven (7) residents interviewed could not corroborate this allegation. R1 was not able to produce invoice for item repaired. Staff interviewed stated they have no control over how residents secure their own personal property, R1 is self responsible and Independent according to physicians’ report dated 11/08/2025. When staff cleans residents’ room, they are cleaning within 20 minutes and do not touch residents’ personal property.
Continued on 809C.......................

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250909133123

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: 09/16/2025

NARRATIVE

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Staff are not aware of persons damaging residents’ belongings. Staff are not aware of cameras hidden in the smoke detectors. According to Administrator the smoke detectors were already installed when purchase of property was made have been inspected by Arcadia fire department annually last fire inspection dated 11/13/2024. Five (5) of five (5) staff interviewed stated each resident has keys to their rooms and are constantly reminded to lock their rooms and report their valuables to staff. Staff stated they have a master key used to enter residents’ rooms for housekeeping. Staff stated they make their presences known and will knock before entering resident’s room. The staff key is kept on the staff person when on duty making rounds. Staff stated they have never left their keys unattended in the presence of residents’. According to the Administrator all master keys are accounted. During physical plant tour LPA Vaid did not observe cameras that were hidden in the smoke detectors. Based upon interviews conducted the findings indicate that, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Facility elevator is in disrepair. It is alleged that the facility elevator is in disrepair. Five (5) of five (5) staff interviewed denied this allegation. Seven (7) of seven (7) residents interviewed could not corroborate this allegation. According to the staff the elevator was malfunctioning in May 2025 and was repaired per invoice. Facility records show that the facility has monthly service for two (2) elevators. During the tour of the physical plant, LPA Vaid observed both elevators in operation. The elevators are aged, slow and are in operation and in constant use by residents. Based upon interviews conducted the findings indicate that, although the allegation may have happened or are 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 was held and copy of this report was provided to Administrator Gil Agas.

Due to printer issues LPA Vaid to mail report to Gil Agas via USPS.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

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