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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 04/18/2022
Date Signed: 04/19/2022 07:39:11 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2021 and conducted by Evaluator Ngozi Nwaokoro
COMPLAINT CONTROL NUMBER: 28-AS-20211124095953
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: 74DATE:
04/18/2022
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Virgilio AgasTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Allegation: Resident was financially abused while in care.
INVESTIGATION FINDINGS:
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Investigation Findings:

12/01/2021, Licensing Program Analyst (LPA) Tao initiated a complaint investigation for the allegations listed above. LPA met Administrator, Virgilio Agas upon arrival.
The investigation consisted of the following: Staff#1, and Resident#1 to Resident #3 were interviewed. A physical plant tour of the facility was conducted. Resident#1 file review was conducted. LPA obtained a copy of resident roster, staff roster, R1's Emergency Information (Face Sheet), R1's physician report, R1's Pre-Placement Appraisal, R1's Needs and service plan, R1’s Admission agreement. Interview was conducted with the Facility Administrator. A hard copy of the report was provided to Administrator.
On 4/18/2022 LPA Ngozi Nwaokoro conducted a supplemental visit that consisted of a facility tour and interviews with staff and residents. LPA obtained a current resident roster and staff roster.

Continued in LIC 9099 C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 918-3347
LICENSING EVALUATOR NAME: Ngozi NwaokoroTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
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 3
Control Number 28-AS-20211124095953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: ARCADIA RETIREMENT VILLAGE
FACILITY NUMBER: 198603401
VISIT DATE: 04/18/2022
NARRATIVE
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The complainant alleges that Resident (R1) was financially abused while in care. According to the complainant, RP indicates that when R1 moved into the facility in November of 2019, R1 was informed that R1 had to surrender R1’s debit card to the management. R1 said the staff, Lourdes Garcia, used the card to purchases things from Target. A caregiver named Anthony is also said to have been a part of the theft. The facility used the debit card to withdraw all of the resident's monthly income which was in excess of what R1 owed the facility. Additionally, the facility made two withdrawals in the month of June 2020 taking all of the resident's stimulus money. The resident estimates $7900 was taken. The resident made a police report in July of 2020 but states R! has received no remedies for this situation. (Case #20-2455) 0MB spoke to Administrator Gil Agas about this matter on 11/23/2021.

LPA Nwaokoro reviews residents’ documents and interview residents and staffs and the following was revealed:

Upon admission to the facility, resident had the option to keep a safe box in resident’s room, to ensure that resident’s rights to retain and use personal possession, but resident refused to take the safe box. According to preplacement appraisal information of 2/22/2019, resident is stated to have periods of forgetfulness, seizure, anxiety, and depression. In a letter from R1 to Administrator, dated 6/24/2020, resident stated that R1 received mail from the U.S Treasury, which was open without R1’s permission. R1 stated that R1 was later presented with $1,200 “stimulus check” made payable to R1 in care of Arcadia Retirement Village, which R1 endorsed to enable the facility to cash at their bank. R1 further gave the facility 48 hours order to return the $1,200 in full. This was a false accusation to management of the facility.

The Administrator responded to the letter on 6/25/2020, stating that upon receipt of the letter, Administrator called R1 for a meeting to clarify allegation. (Letter enclosed). R1 stated that he cannot read and that his hands are not able to type or write anything. That someone, a resident, type the letter for R1, the resident read it to R1, and it sounds good and R1 to sign. (Letter enclosed). Also enclosed is R1bank statement from Bank of America showing withdrawals and dates.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 918-3347
LICENSING EVALUATOR NAME: Ngozi NwaokoroTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20211124095953
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: ARCADIA RETIREMENT VILLAGE
FACILITY NUMBER: 198603401
VISIT DATE: 04/18/2022
NARRATIVE
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Record of Client Safeguarded Cash Resources for R1 from 10/1/2018 shows cash flow of monies given to R1 with dates and signature. ( enclosed among reviewed documents), Invoice from Arcadia Retirement Village shows rent owed by R1 from July, Aug, & Sept 2020, $3,235.11, Oct, Nov & Dec 2020, $3,268.11, Unpaid in 2021, $13,192.44 and Jan, Feb, Mar and Apr 2022, $4,847.08, amounting to $24, 542.74, R1 is owing the facility.

Resident 1-5 (R2- R5) were interviewed and revealed the following: R2 Acknowledged knowing R1 from years back, R1 looks at the facility brochures and say, “They are not doing what they promised in the brochure, so I will not pay my rent”. R2 stated that apart from R1 case, he has not heard of any financial abuse to residents as the facility is doing a good job. R3 stated that he has not heard of any issue of financial abuse, no resident has complained to R3’s hearing and R3 have not experience any financial abuse in the facility. R3 stated that a resident once took R3’s credit card and used $608 and never paid back. The resident was an alcoholic, but that resident is no more living in the facility. R4 likes living at the facility and have not heard of any financial abuse to residents by management. R5 does not have any complaint as everything is good here. R5 has not had issues with her finances.

Staff 1-5 (S1- S2) were interviewed and revealed the following: Administrator reveal that he knows resident and remembered the case. He stated that till date, R1has refused the pay the facility for services render to him. He stated that they have a record of R1cash flow and what he is obliged to pay the facility, yet the facility provide care to R1. S1 said she has worked in the facility for three years and have never heard of any financial allegation from residents on fund mismanagement. S2 specified that most of the residents do not pay their rents, “people like R1” not sure why R1 declines paying rent? R1 confided to S2 that R1 wants to move to another facility. S3 affirmed that S3 has not heard about mismanagement of resident funds. S4 also indicated same, that S4 has not heard any complaints of resident fund mismanagement. S5 stated that no resident has complains financial abuse, but S5 is concerned about a resident that is aggressive towards staff. Apart from that, S5 has not heard of any resident having issue with their money, or facility is withholding their money.

Based on LPA observations, and review of documents and interviews conducted. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 918-3347
LICENSING EVALUATOR NAME: Ngozi NwaokoroTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3