198603401-12-20-2022-28-AS-MVAO-CMJSHD-20221228125321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 12/20/2022
Date Signed: 12/20/2022 03:50:33 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
12/14/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20221214145307

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: 83	DATE:	12/20/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	VIRGILIO AGAS, administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff searched resident's personal property without consent.
Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegation listed above today. During today’s visit, LPA met Administrator, Gil Agas. LPA explained the purpose of today's visit regarding the above-mentioned allegations.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #6 (S6); interviews of residents from Resident#1 (R1) through Resident#7(R7); reviewed resident#1’s record; and a facility tour.

LPA obtained copies of the Staff and Resident Rosters; and resident files for Resident #1 (R1) with relevant information.

(-continued in LIC 9099 C-)

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: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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-20221214145307

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: 12/20/2022

NARRATIVE

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In regard of the allegation, “staff searched resident's personal property without consent” it was alleged that administrator went through resident#1’s purse around September 2022 without resident#1’s consent. The investigation revealed the following: Interviewed with resident#1(R1), resident stated administrator searched R1's purse and claimed that a check was missing but no documentary proof. Six (6) out of seven (7) residents interviewed revealed that administrator or staff had never gone through their personal property without resident’s consent. Six (6) out of six (6) staff, including the administrator, denied the allegation. File review revealed resident#1 did not report any personal property missing during September 2022. Therefore, there is not a preponderance evidence to prove the administrator had searched resident’s personal property.

In regard of the allegation, “Facility is in disrepair” it was alleged that facility had a history of not fixing items. The investigation revealed the following: Interviewed with resident#1, resident said there were a broken blind in resident’s room in the past. Six (6) out of seven (7) residents interviewed revealed that their rooms not in disrepair. Six (6) out of six (6) staff, including the administrator, denied the allegation. LPA tour the facility during resident interview, LPA did not observe the facility had broken items. Therefore, there is not a preponderance evidence to prove the facility is in disrepair.

Although the allegations 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 allegations are UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Administrator. A hard copy of this 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: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC9099 (FAS) - (06/04)

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