198603401-6-27-2022-28-AS-FFIS-CGVULP-20220801154101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 06/27/2022
Date Signed: 06/27/2022 10:36:00 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, 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
04/02/2021 and conducted by Evaluator Elizabeth Ceniceros

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210402112024

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: 70	DATE:	06/27/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Administrator, Virgilio Agas		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff mishandles residents' medications while in care.

Staff not properly trained to administer medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Administrator (Virgilio Agas). The purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

A virtual 10-Day visit was conducted by LPA Bonnie Tao on 04/07/21 (via telephonically) with Administrator (Virgilio Agas) due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures. During the virtual video conference call with Administrator Agas, LPA Tao conducted a virtual tour of the facility’s physical plant that included the facility's medication room. LPA Tao conducted telephone interviews with Staff #1, Staff #2, and Staff #4. LPA Tao obtained Staff and Residents’ rosters; and, a short video recording of the medication cart left unattended in the hallway. LPA Tao requested pertinent documents: Staffs’ In-Service Medication Training Sign-in Sheets and Job Descriptions for the Med Tech and PCA-Caregiver positions.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Araceli Ramirez	TELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

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-20210402112024

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198603401
	VISIT DATE: 06/27/2022

NARRATIVE

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Regarding Allegation #1: this investigation revealed that residents' medications are prepared and administered by the Med Techs assigned to each shift (A.M., P.M., NOC). Medications are stored in bubble packs and administered by prescription. LPA Bonnie Tao conducted a virtual tour of the facility’s physical plant that included the facility's medication room. Non-Med Techs (PCA-Caregivers) do not prepare or administer medications to the residents. Med Techs receive 40-hours of training (annually) by a Pharmacist from B & B Pharmacy. Interviews conducted, corroborated the Med Techs for each shift (A.M., P.M., NOC) administers medications to the residents; and, medications are only prepared for his/her shift. If a Med Tech is not available for his/her shift, Administrator Agas will ask another Med Tech (if available) to cover the next Med Tech's shift; if not, Administrator (Virgilio Agas) or the Licensee (Dr. Kang Shin) will prepare and administer medications to the residents for the absent shift.

Based on the evidence gathered and interviews conducted and records reviewed, 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 of MEDICATION: Staff mishandles residents medications while in care is found to be UNSUBSTANTIATED.

Regarding Allegation #3: this investigation revealed Med Techs receive 40 hours of medication training (annually) by a Pharmacist from B & B Pharmacy. A review of the Job Description for Med Tech position documents: Med Techs general responsibility and duties is to oversee medication services; and for the PCA- Caregiver position; it does not document providing medication services. Interviews conducted, corroborated that the Med Techs for each shift (A.M., P.M., NOC) receives his/her medication verification training upon hire and annually; thereafter. A review of the Staffs’ In-Service Medication Training covered topics: "Medication Pass, Medication Documentation, Common Medications Overview, First Aid".

Based on the evidence gathered and interviews conducted and records reviewed, 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 of OTHER: Staff not trained to administer medications is found to be UNSUBSTANTIATED.

An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator (Virgilio Agas).

SUPERVISOR'S NAME: Araceli Ramirez	TELEPHONE: (323) 980-4925
LICENSING EVALUATOR NAME: Elizabeth Ceniceros	TELEPHONE: (916) 264-1579
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC9099 (FAS) - (06/04)

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