198603401-2-24-2022-28-AS-MVAO-CHCRPB-20220816131141

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 02/24/2022
Date Signed: 02/24/2022 07:19:08 PM

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
02/18/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220218132454

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: 67	DATE:	02/24/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Agas Virgilio, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Residents belonging are being stolen by another resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao, conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Administrator, Agas Virgilio. LPA explained the purpose of today’s visit is to discuss the above mentioned allegation.

The investigation consisted of resident interviews, staff interviews, facility tour, and review of facility records. LPA Tao spoke with Administrator and obtained Resident roster, Staff roster, Resident #1’s (R1) Physician report; R1 Identification and Emergency information; R1 Pre-Appraisal; R1’s Resident Property and Valuable; R1 Need and service plan; and R1’s Incident report dated Nov 26, 2021.

The investigation revealed the following:
In regard to allegation “Residents belonging are being stolen by another resident," it was alleged that Resident #1 (R1) steals other residents’ belonging. Seven (7) out of seven (7) residents interviews revealed that R1 did not steal other residents’ belongings. (- Continued in LIC 9099C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022

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-20220218132454

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: 02/24/2022

NARRATIVE

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Residents interviews could not corroborate the allegation. Six (6) out of six (6) staff denied the allegation. Staff interviews revealed that there is no evidence to show R1 stealing other residents’ belongings. File review did not reveal R1 stealing from other residents. Therefore, LPA could not corroborate 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.

An exit interview was conducted with Administrator. A hard copy of the report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022

LIC9099 (FAS) - (06/04)

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