198603401-10-6-2021-28-AS-CYEE-C972LN-20211127162950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 10/06/2021
Date Signed: 10/06/2021 01:59:27 PM

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
09/27/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210927131807

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: 72	DATE:	10/06/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Virgilio Agas, administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff refused to assist resident with their medication management
Staff failed to provide adequate laundry service

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicole Spencer conducted an initial complaint investigation for the allegations listed above. LPA Spencer met with administrator Virgilio Agas and explained the purpose of today's visit.
The investigation consisted of the following: On 10/6/21, LPA took a tour of the facility including the med room, laundry rooms, and a random sample of (7) resident rooms. LPA interviewed the administrator, staff #1-4 (S1-S4), residents #1-7 (R1-R7), and R1's pharmacist (P1). LPA attempted to interview R1's physician but was unsuccessful. LPA obtained copies of the staff roster, resident roster, laundry schedule and for R1: admissions agreement, physician's report, prescription for new medication, and MAR log.

The investigation revealed the following: It was alleged that facility staff refused to assist a resident with their medication management after a change in medication. Per review of R1's prescription, the physician ordered two (2) new medications on 9/22/21: Furosemide 20 mg (evening) and Lorazepam .5 mg (as needed). ***See LIC9099C for continuation of narrative***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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-20210927131807

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: 10/06/2021

NARRATIVE

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The prescription from pharmacy shows that the Furosemide 20 mg was ordered on 9/22/21 and filled on 9/27/21 and Lorazepam .5 mg was ordered and filled on 9/22/21. MAR logs reveal that R1 was given Furosemide 20 mg starting on 9/27/21 and Lorazepam is given as needed. When interviewed, the physician (P1) stated that Lorazepam was delivered to the facility on 9/22/21, but there was a delay in Furosemide because the pharmacy had to verify with the physician if this was a change in dosage or to be given concurrently with higher dosage (Furosemide 40 mg). P1 stated that Furosemide 20 mg was filled and delivered to facility on 9/27/21. All staff interviewed denied the allegation that staff refused to assist resident with their medication management. Staff stated that the facility was not informed about the change in medications but S2 called the pharmacy on 9/22/21 to verify when R1 inquired about the new medications. Staff stated that once the new medications were verified and delivered to the facility, they were given as prescribed. A review of the MAR logs and LPA's observation of the medications verify that the medications were present at the facility and given as prescribed. Six (6) out of seven (7) residents interviewed stated that staff assist them with their medications and they receive all of their medications as prescribed.
Staff failed to provide adequate laundry service
It was alleged that facility staff failed to provide adequate laundry service due to clothes and sheets having odor and stains after being washed. Per review of laundry service, each residents laundry is cleaned once per week. The admissions agreement states that residents have independent access to washers and dryers and additional laundry and housekeeping services are available. LPA observed the laundry rooms and the detergents used, as well as the extra set of linens which appeared clean and did not have an odor. LPA also observed the linens and clothes for a random sample of seven residents and the linens appeared clean and did not have an odor. The administrator and S1 denied that the facility does not provide adequate laundry service stating that laundry services are done once a week, while S2-S4 do not work with housekeeping and were unaware of the issue. The administrator stated that most residents prefer to do their own laundry, but sheets are changed as needed or at least every 3 days. Six (6) out of seven (7) residents interviewed stated that they are satisfied with laundry services provided and have not noticed odor or stains in laundry.

Based upon interviews, observation, and records reviewed, the findings indicate although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated. An exit interview was conducted with Administrator and a hard copy of the report was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC9099 (FAS) - (06/04)

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