198603401-4-19-2022-28-AS-MVAO-CELTLB-20220520144915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 04/18/2022
Date Signed: 04/19/2022 07:32:09 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
11/29/2021 and conducted by Evaluator Ngozi Nwaokoro

COMPLAINT CONTROL NUMBER: 28-AS-20211129092023

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:	04/18/2022
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Virgilio Agas		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Allegation: Financial Issues.

INVESTIGATION FINDINGS:

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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. 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 Kendrick	TELEPHONE: (323) 918-3347
LICENSING EVALUATOR NAME: Ngozi Nwaokoro	TELEPHONE: (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-20211129092023

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) had financially issues. According to the complainant, RP met with R1 who explained that the Alleged resident borrowed money from R1 and has not paid back the sum of $680, which put R1 in arrears with the RCFE. R1 further stated that the alleged resident owes another resident the sum of $1,000 and R1 believes there might be other residents who are victims. R1 stated that the alleged resident comes to R1 frequently and asks for money even after R1 has told the alleged resident that R1 is "poor" and cannot give the alleged any more money. RP spoke to Administrator, who confirmed the allegation and also aware of R1 situation. The administrator stated the R1 had agreed to accept a payment plan from the alleged to get back on track. The Administrator went further to say that alleged resident is not paying the facility what they owe them either. RP expressed concerns that the alleged resident may owe other residents’ money and may be manipulative in trying to obtain money from residents. The Administrator confirmed that a staff member recently reported to him that the alleged resident was seen going to other residents’ rooms. RP asked what steps the facility was taking to keep the other residents safe and the administrator stated that the alleged resident will be evicted from the facility.

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

R1 stated that the alleged borrowed money from R1, stating that R1 gave the allege resident their credit card to use because the alleged was an alcoholic. R1 states that R1’s finances were the problem because the alleged resident did not pay R1 back the money owed. R1 further stated that R1 is happy now because the alleged is no longer in the facility. R2 stated that apart from R1 case, R2 has not heard of any financial issues, the facility is doing a good job. R3 stated that R# has not heard of any financial issue from any resident, as no one has complained to R3’s hearing and R3 have not experience any financial abuse from any resident in the facility. R4 stated that a resident once took R1’s credit card and used $680 and never paid back. “The resident was an alcoholic, but that resident is no more living in the facility”. R5 likes living in the facility and have not heard of any financial issue from any residents. R5 does not have any complaint as everything is good here, R5 stated.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 918-3347
LICENSING EVALUATOR NAME: Ngozi Nwaokoro	TELEPHONE: (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)

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Control Number 28-AS-20211129092023

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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Staff 1-5 (S1- S2) were interviewed and revealed the following: Interview with the Administrator revealed that the alleged resident was also owing the facility. The administrator confirmed that the alleged resident was an alcoholic, after borrowing money from R1, R1 was unable to pay their rent, but the administrator assisted R1 to call the police and ombudsman. The administrator stated that, to keep other residents safe, when the opportunity to evict the alleged resident came, the alleged was not allowed back to the facility. S1 said she has worked in the facility for three years and have never heard of any resident having financial issues. S2 stated that the problems the facility encounter is that some residents do not pay their rent. For the problem with R1, the alleged resident has been evicted from the facility. S3 stated that, S3 have not hearing of any resident having financial issues. S4 also declared not hearing any complaints of resident’s financial issues. S5 stated that no resident has complained of financial issues, 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 resident’s money.

From document reviewed, a letter was sent to the alleged resident from the facility on 6/2/2021, reminding the alleged that upon admission, it was clearly explained that drinking alcohol was prohibited in the facility. Resident was advised about it, but since resident cannot stop, Arcadia Retirement Village is not responsible to anything that may happen to the resident, effective 6/2/2021. The alleged resident was asked to acknowledge the letter by signing the agreement, which resident did.

Based on LPA observations, and review of documents and interviews conducted; although the allegations may have happened or is valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 918-3347
LICENSING EVALUATOR NAME: Ngozi Nwaokoro	TELEPHONE: (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)

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Control Number 28-AS-20211129092023

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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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 Kendrick	TELEPHONE: (323) 918-3347
LICENSING EVALUATOR NAME: Ngozi Nwaokoro	TELEPHONE: (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)

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