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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 10/30/2025
Date Signed: 10/30/2025 02:35:15 PM

Substantiated


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
10/28/2025 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251028121846
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: 68DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Virgilio Agas, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff did not provide a safe/comfortable environment for resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vaid conducted a initial 10-day complaint to the facility, met with Administrator Virgilio (Gil) Agas and discussed the allegation mentioned above.

LPA requested, obtained and reviewed the resident roster, staff roster, Client#1(C1) and client #2(C2) face sheet, physicians report, pre-placement, needs and services and medications list. LPA interviewed five (5) staff, seven (7) residents and one (1) witness.

The investigation revealed the following:

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

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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-20251028121846
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: 10/30/2025
NARRATIVE
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Regarding the allegation: Facility staff did not provide a safe/comfortable environment for residents in care. It is alleged that the facility staff are not providing a safe and comfortable environment for resident #1(R1) in care and is Resident #2 (R2) is constantly verbally abusing R1 and staff are not expressing concerns about R1's safety. Five (5) of five (5) staff interviewed deny this allegation, staff stated they are keeping a watchful eye over the residents that exchange verbal insults and have redirected residents when conflicts between residents R1 and R2 arise. Two (2) of five (5) staff interviewed stated they have observed R2 verbally abusing R1 and have intervened and redirected R2. Three (3) of Five (5) staff stated R2 constantly is verbally abusing R1. The Administrator is aware of the history between R1 and R2 and has not created plan of moving R1 to another room. According to Witness #1, the facility has three empty shared rooms #107, 113 and 201 and one empty bed in rooms 224 and 119, therefore Administrator could have prevented this incident from occurring. Four (4) out of seven (7) residents interviewed stated they do not feel safe residing at the facility, due to residents becoming unruly and display behaviors of yelling, cursing and sometimes throwing things to the floor and breaking them resulting in other residents becoming afraid of unruly residents behaviors. R1 & R2 were roommates, altercations between R1 & R2 occured 07/24/25 and 08/06/25 and 10/28/25 and that the administrator was aware that R1 was being verbally abused by R2 and R1 and R2 were no longer compatible as roommates, however, the administrator did not create a plan to separate the R1 and R2. Administrator provided new room for R2 during today’s visit. Based on LPA's observations and interviews which were conducted and record reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D.

Exit interview was conducted, copy of 9099, 9099C, 9099D and appeals report were provided to the Administrator Gil Agas.


Refused to sign.9099c and 9099D pages.
Appeals were left with Administrator.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20251028121846
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/28/2025
Section Cited
CCR
87468.1(a)(2)
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87468.1Personal Rights of Residents in All Facilities: (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations.
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In-Service training provided to staff regarding compatibility of residents and their safety. POC to be completed and emailed to LPA by 11/07/25.
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This requirement was not met by: R1 and R2 have had history of non-compatibility, Administrator was aware and did not create a plan to move resident R2 to another empty room and creating unsafe environment for R1.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3