198603401-6-20-2023-28-AS-FFIS-CT2MFF-20230622093412

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 06/20/2023
Date Signed: 06/20/2023 05:03:26 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
04/16/2021 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20210416161448

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:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Virgilio Agas, administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Lack of supervision resulting in resident engaging in a physical altercation with another resident.
Staff did not provide resident with medication.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the complaint investigation reports created on 04/29/22. The findings remained unsubstantiated. ***

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

On 04/19/21, LPA Tao conducted the initial investigation visit telephonically due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures. LPA obtained staff / resident roster, resident #1’s (R1) / resident #2’s (R2) facility files, and staff’s training records. LPA Tao interviewed staff#1 (S1), resident#1 (R1) and resident#2 (R2).

(-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: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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-20210416161448

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: 06/20/2023

NARRATIVE

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***This report serves as an amendment and supersedes the complaint investigation reports created on 04/29/22. The findings remained unsubstantiated. ***

On 04/14/22, LPA Antonia Alvizar and Licensing Program Manager (LPM) Ulysses Coronel conducted a subsequent complaint investigation on the above allegations. During the visit, LPA and LPM interviewed S1 for further information.

On 04/12/23 and 04/28/23, LPA Alvizar reviewed facility’s records obtained by LPA Tao.

On 04/29/22, LPA Antonia Alvizar and Licensing Program Manager (LPM) Ulysses Coronel conducted another subsequent complaint investigation on the above allegations. During the visit, LPA and LPM conducted interviews with staff#2 (S2), and residents from resident#3 (R3) through resident#7 (R7); and toured the facility.

On 06/20/23, LPA Tao conducted another subsequent visit today. During the visit, LPA obtained copies of staff and resident rosters, conducted a facility tour; and re-delivered findings.

Investigation consisted of the following:
LPAs interviewed staff from S1 to S2; interviewed residents from R1 through R7; reviewed R1 and R2’s record; and conducted facility tours.

Investigation revealed the following:
In regard of the allegation, ‘lack of supervision resulting in resident engaging in a physical altercation with another resident.” it was alleged that resident#1 and resident#2 had a physical altercation at the facility and staff did not intervene. LPAs interviewed residents, six (6) out of seven (7) residents could not corroborate the allegation. R3 declined to be interviewed. Per residents’ interviews, R1 and R2 were in a romantic relationship. They would have a fight like a couple’s argument which was related to their personal relationship, not staff’s negligence. All interviewed staff denied the allegation. Staffs’ and residents’ interviews reviewed staff had intervened and attempted to separate the residents during the incident. R1 and R2 were still in a relationship after the incident. Therefore, residents engaged in a fight was not due to lack of facility supervision and staff had intervened during the incident.
(-continued in LIC 9099 C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210416161448

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: 06/20/2023

NARRATIVE

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***This report serves as an amendment and supersedes the complaint investigation reports created on 04/29/22. The findings remained unsubstantiated. ***

In regard of the allegation, “staff did not provide resident with medication,” it was alleged that staff did not provide medication to R1 while being taken into police custody. LPAs interviewed residents, six (6) out of seven (7) residents could not corroborate the allegation. R3 declined to be interviewed. Per residents’ interviews, residents would get their medication as prescribed. All interviewed staff denied the allegation. Staff interviews revealed that police stopped staff to give R1 medication when police were taking R1’s custody. Therefore, there is not preponderance evidence to prove staff failed to provide resident with medication.

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.

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

An exit interview was conducted with Administrator, Gil Agas. 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: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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