198603401-6-15-2022-28-AS-MVAO-CFETNF-20220615145241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 04/29/2022
Date Signed: 06/15/2022 11:02:25 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
08/02/2021 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210802083931

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: 77	DATE:	04/29/2022
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Virgilio Agas		TIME COMPLETED:	04:58 PM

ALLEGATION(S):

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Staff does not respond to resident's call button.
Staff did not administer resident's medication as prescribed.

INVESTIGATION FINDINGS:

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On 04/29/2022 Licensing Program Analyst (LPA) Antonia Alvizar and Licensing Program Manager (LPM) Ulysses Coronel conducted a subsequent complaint investigation on the allegations listed above. LPA Alvizar and LPM Coronel met with administrator Virgilio Agas the administrator.

The investigation consisted of the following: On 08/10/2021 LPA Bonnie Tao interviewed staff administrator, residents and obtained resident roster and staff roster. . On 04/14/2022 LPA Alvizar and LPM Coronel interviewed Administrator Agas, 1 staff and reviewed the facility’s alert monitoring system at the receptionist office. On 4/29/2022 LPA Alvizar and LPM Coronel interviewed 5 resident and 1 Staff and conducted a tour of the facility.

Report continues on LIC9099.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210802083931

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: 04/29/2022

NARRATIVE

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The investigation revealed the following: Regarding the allegation: “Staff does not respond to resident’s call button.” On 04/29/2022 during interviews conducted, 1 out of 5 residents agreed with the allegation, resident R3 stated “Yes, they don’t respond, sometimes caregivers do not show up until a half hour later”. 1 out of 5 residents did not provide an answer. 3 out of 5 residents disagreed with the allegation, resident R1 stated “Last week I used it and they did alright they responded”. 3 out of 3 staff interviewed disagreed with the allegation. 04/14/2022 staff S1 stated "The call button can only be turned off at the residents room". On 04/29/2022 LPA Alvizar tested the call buttons in the following rooms: #119, #118, #114, #228 and #115 it was observed that the call buttons were working and caregivers responded within an average of 3 to 5 minutes for caregivers to check on the residents. Regarding the allegation: “Staff does not respond to resident’s call button” 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.”

Regarding the allegation: “Staff did not administer resident’s medication as prescribed.” It is alleged that staff do not give PRN Medications when requested by residents. On 04/29/2022 during interviews conducted, 1 out of 5 residents did not provide an answer. 4 out of 5 residents disagreed with the allegation, resident R4 stated “They did not have enough staff, but they are doing better “. 3 out of 3 staff interviewed disagreed with the allegation. 04/14/2021 administrator Agas stated “I don’t think so because Medical Technicians always follow the doctors instructions, we can’t supersede doctors written orders”. Regarding the allegation: “Staff did not administer resident’s medication as prescribed.” 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.”

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.”

No deficiencies cited. An exit interview was conducted, and a copy of this report was provided to Virgilio Agas.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC9099 (FAS) - (06/04)

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