198603401-2-27-2023-28-AS-RORN-CQDSSA-20230329140737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 02/27/2023
Date Signed: 02/27/2023 04:51:06 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
02/21/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230221143614

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: 79	DATE:	02/27/2023
		UNANNOUNCED	TIME BEGAN:	08:01 AM
MET WITH:	Gil Agas, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff are withholding resident's property.
Facility staff won't assist resident with ordering a new ambulation device.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegations listed above today. LPA met Administrator, Gil Agas and explained the purpose of today's complaint investigation visit.

During the investigation visit was conducted, LPA Tao obtained staff roster, resident roster, resident#1’s (R1) records, interviewed residents from resident#1 (R1) to resident#3 (R3), interviewed staff from staff#1 (S1) to staff #4 (S4), and conducted a facility tour.

The investigation revealed the following: In regard of allegation, “facility staff are withholding resident's property,” it was alleged that resident#1(R1)’s electrical wheelchair was broken on Oct 2021, stored in a storage and never returned to R1. LPA interviewed residents who are using electrical wheelchair. R1 stated staff withheld R1’s electrical wheelchair. Two (2) out of three (3) residents stated staff had never withheld their electrical wheelchairs. All staff interviewed denied the allegation.
(-continued in LIC9099C-)

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: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

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-20230221143614

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: 02/27/2023

NARRATIVE

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LPA toured the facility and observed the R1’s broken wheelchair was stored in a storage room. R1’s broken wheelchair was in a very bad condition, not operable and not safe to use. It would be a trip hazard if the broken wheelchair was placed in resident’s room per resident’s ambulatory status. Per R1’s file review, R1’s wheelchair was broken prior to May 2021. Staff had initiated the process and attempted to get a new electrical wheelchair to resident for replacing the broken one. Thus, facility staff are not withholding resident's property of a broken electrical wheelchair but preventing trip hazard to resident while in care.

In regard of allegation, “facility staff won't assist resident with ordering a new ambulation device,” it was alleged that resident#1(R1) requested staff to submit an order of a new wheelchair on R1’s behalf but did not have progress. LPA interviewed residents who are using electrical wheelchair. R1 stated staff did not follow up R1’s progress on ordering the new wheelchair. Two (2) out of three (3) residents could not corroborate the allegation. All staff interviewed denied the allegation. Per R1’s file review, R1’s wheelchair request was submitted since May 2021. The process was stopped due to R1 refused to be seen by R1’s primary doctor for an evaluation of a new electrical wheelchair, therefore, no doctor’s order for a new electrical wheelchair was on file. Staff had attempted to encourage R1 to be seen by doctor, but all attempts failed. During resident interview, R1 agreed to be seen by doctor for an evaluation for electrical wheelchair request and resume the process of getting a new electrical wheelchair. R1's primary doctor was contact to schedule appointment. Thus, facility staff had assist resident with ordering a new ambulation device.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator, Gil Agas and findings were discussed. A copy this report was provided to Administrator at time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC9099 (FAS) - (06/04)

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