198603401-12-30-2022-28-AS-RORN-CMQR6N-20230103114502

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 11/09/2022
Date Signed: 12/30/2022 04:40:03 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
09/24/2021 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210924100857

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: 84	DATE:	11/09/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator, Virgilio Agas		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Residents are not provided assistance when needed.
Facility does not have hot water.
Facility is in disrepair.
Food service is inadequate.
Staff did not safeguard resident's personal items.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

*****This is an amended version of the report dated 11/09/2022. The reason for amendment is the initial report contained confidential information that has now been removed. No other changes have been made to the report. *****

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit regarding the above stated allegations. LPA met with Administrator Virgilio 'Gil' Agas and explained the reason for the visit.

During the initial visit conducted by LPA David Sicairos on 9/30/2021, LPA obtained copies of resident and staff rosters. LPA toured the common areas of the facility with the Administrator which included the kitchen, dining room, and common bathrooms. LPA also interviewed the Administrator and Resident #1 (R1).

During today's visit, the investigation consisted of the following: LPA Pena obtained copies of resident/staff roster, LPA toured the common areas, interviewed Resident #1-Resident #11 (R1-R11), Staff #1-Staff #5 (S1-S5), in-service training regarding residents personal belongings, plumbing service invoices (Sep-Oct 2021, Dec 2021-Jan 2022 and June 20222) and food purchase/order invoices (Sep 2021-Oct 2021).

****REPORT CONTINUED ON LIC 9099-C*******

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

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 5

Control Number 28-AS-20210924100857

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: 11/09/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding allegation: Residents are not provided assistance when needed.

It was alleged that there is no staff at the front desk between 8am-9am and residents can not get assistance with something when they call between those hours. The investigation revealed that S1 indicated that the front desk staff starts work at 7am daily. If the staff steps out, the calls get forwarded to their cell phones so they can answer even if they are not at their desk. S1 also stated that if no one answers, the call goes to voicemail and a staff will make sure to return the call. S1 indicated that sometimes, the front desk can be on the other line when a call comes in, but staff will call back the resident as soon as possible. S1 denied the allegation. S2-5 stated that they never heard any resident complain about assistance not being provided when needed and therefore denied the allegation. Ten (10) of the eleven (11) residents interviewed stated that they never had any issues with assistance from the staff. Some stated that sometimes they have to wait for a few minutes, not a long wait before a staff attends to their needs. All (11) residents stated that their calls get answered from the front desk staff when they call to ask for assistance and never had issues with that. Based on statements and interviews conducted with residents and staff, there was not enough supportive evidence to corroborate the 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.

Regarding allegation: Facility does not have hot water.

It was alleged that the facility is without hot water every three (3) days. S1 denied the allegation and said not having hot water for three (3) days did not happen. S1 admitted that the boiler system went out some time last year, one of the pipes blew out. S1 called the plumber and it was worked on and fixed in one (1) day. S1 indicated that he notified the residents about the hot water situation that morning. S2-5 stated that sometimes the facility conducts a hot water maintenance but it will only be out for an hour or so. S2-5 indicated that the maintenance is being done once every 4-6 months.
******REPORT CONTINUED ON LIC9099-C********

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20210924100857

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: 11/09/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

During LPA's investigation and interview, R1 stated that the hot water issue has been taken care of. R10 stated that sometimes they shut down the hotel water to have it fixed but they notify the residents before and it was never every 3 days. R11 stated that facility has hot water all the time except when they fixed the water heater about six (6) months ago. R2-9 stated that they never had an issue with hot water and denied having no hot water for 3 days. LPA reviewed the plumbing service invoices (12/02/2021, 01/03/2022, 6/29/2022) and revealed that the hot water boiler system was fixed/replaced and vendors conducted regular maintenance. Based on resident interviews, staff interviews and reviewed documentation, there was not enough supportive evidence to corroborate the 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.

Regarding allegation: Facility is in disrepair.

It was alleged that the bathroom in the 1st floor near the dining room does not work and has not been working for a long time now. S1 stated that the bathroom by the dining room currently works and if there was a problem with that bathroom, there are other bathrooms in the first floor that can be used. S2-S5 stated that this is an old building and there are things that break down sometimes, but S1 and other staff take care of it right away. R5 stated that when something goes wrong, they fix it – sometimes it takes a while but they get around to it eventually. R10 stated: "there were issues in the facility here and there that needs to be fixed but personally I like the place." R1 stated that the floors in some areas are coming apart because they replaced it with cheap materials. R2-R11 stated that the facility is not in disrepair and they don't have any issues or concerns. LPA observed that the floor in the 1st floor hallway appears to have been covered with a duct tape across some areas. LPA observed that residents pass through it with their wheelchairs or walkers and have no problem. LPA observed that it does not appear to be a hazard or to a point that it could cause fall or injury at this time. *****REPORT CONTINUED ON LIC9099-C******

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20210924100857

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: 11/09/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

S1 stated that they have the materials ready, just awaiting for the floor vendor to come and replace the flooring. Based on resident interviews, staff interviews and LPA's observations, there was not enough supportive evidence to corroborate the 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.

Regarding allegation: Food service is inadequate.

It was alleged that the food service is not great , the food is either over or undercooked.And the facility can be without milk for days as well. S1 denied the allegation and stated that the facility has never been out of milk and could provide receipts of their milk purchases. S1 also stated that he was not aware of any complaints regarding this. R2-R11 stated that the food is okay and adequate, food not great sometimes but no issues. Additionally, they indicated that if any of them did not like the menu, they were given an option to eat a sandwich instead. Some of them indicated that food needs improvement especially in taste but the quality and serving are enough. S2-5 stated that they never heard anyone complaint about the food service not great. S2-5 indicated that they denied the allegation about not having milk for days. LPA observed the food served in the dining area during the residents' lunch time and appeared to be healthy and balanced. Based on statements, interviews conducted with residents and staff, as well as LPAs observations, there was not enough supportive evidence to corroborate the 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.

********REPORT CONTINUED ON LIC9099-C******

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 28-AS-20210924100857

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: 11/09/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding allegation: Staff did not safeguard resident's personal items.

It was alleged that R1 had birthday balloons in her room and now they're missing. During LPA's interview with R1, she indicated that this has been resolved with the help of S1. S3-S5 stated that they respect the residents and do not touch their things. S3-S5 stated that they do not go inside the resident's room without permission. With regards to the missing balloons, S2-S5 indicated that they were not aware of that and guessed that maybe they were thrown by accident. S1 stated that a resident came up and told him that she had missing balloons. S1 instructed housekeepers that in the future, do not remove anything in the resident's rooms without asking them first if it's okay to be removed/thrown away. R5 indicated that although staff safeguard their personal items, he stated: "one of the residents here steal something." R2-R4, R6-R11 stated that they were encouraged by the staff to lock their rooms whenever they leave to avoid missing valuable items. Some of them stated that they do not have an issue with that because they keep their valuables with them whenever they go. Some of them stated that they do not have any money or valuables so that was never an issue for them. R10 stated that he has a lockbox in the bank and that's where he keeps his valuables.
Based on statements and interviews conducted with residents and staff, there was not enough supportive evidence to corroborate the 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 was conducted and a copy of this report was provided to the Administrator, Virgilio Agas.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5