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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 09/22/2025
Date Signed: 09/22/2025 02:35:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/22/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250522144737
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: 69DATE:
09/22/2025
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Virgilio "Gil" Agas - AdministratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff did not ensure resident was transported to medical appointment in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera made an unannounced subsequent visit at the facility to investigate the above-mentioned allegation. LPA met with Administrator Virgilio "Gil" Agas, and explained the purpose for the visit.

On 5/30/25 LPA Nicol Wesley conducted the initial visit and obtained copies of the staff/resident rosters, requested a log for the individuals who can not schedule/arrange medical appointments, interviewed staff and residents. During todays visit 9/22/25 LPA Herrera obtained copies of the staff/resident rosters, copy of Resident #1's (R1) Hermodialysis Flowsheets for the month of May 2025 were provided, LPA toured facility, interviewed 3 staff (S1-S3) and 9 residents (R1-R9).

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
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 2
Control Number 28-AS-20250522144737
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ARCADIA RETIREMENT VILLAGE
FACILITY NUMBER: 198603401
VISIT DATE: 09/22/2025
NARRATIVE
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The Investigation Revealed the Following:
Allegation: Staff did not ensure resident was transported to medical appointment in a timely manner.
It is alleged that on 5/21/25 R1 reported missing 2 dialysis appointments due to staff not assisting with transportation to the appointment. LPA interviewed 3 staff and each denied the above allegation. Interview with S3 revealed that although the dialysis team may show up later than the scheduled time, they do show up to provide treatment for R1. LPA interviewed 9 residents and 8 out of 9 residents denied the allegation. Interview with R1 revealed that they receive treatment for dialysis at the facility and do not need to have transportation for this service, they also stated that sometimes the dialysis office will call and reschedule the time for treatment or reschedule the appointment for the following date, R1 stated that they should receive treatment every 2-3 days. LPA reviewed R1’s Hemodialysis Flowsheet for the month of May 2025 which documented that dialysis treatment was done on the following dates: 5/2/25, 5/5/25, 5/7/25, 5/9/25, 5/12/25, 5/15/25, 5/18/25, 5/21/25, 5/24/25, 5/26/25, 5/28/25, 5/30/25, which reflects the requirement of treatment for R1 (every 2-3 days).

Based on statements and interviews conducted with staff/residents, and review of resident files, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is 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 held, and a copy of this report was emailed to administrator.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2