198603401-6-20-2023-28-AS-RORN-CU3Q5C-20230725115139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 06/20/2023
Date Signed: 06/20/2023 05:04:16 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
06/12/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230612152216

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:	01:00 PM
MET WITH:	Virgilio Agas, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not afford residents in care with dignity and respect in their relationship.
Staff do not prevent cigarette smoke from entering the facility.
Facility is in disrepair.
Elevator is not working properly.
Facility food is of poor quality.

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.

Investigation consisted of the following:
LPA Tao obtained staff roster, resident roster, and resident#1’s (R1) records; interviewed residents from resident#1 (R1) to resident#8 (R8); interviewed staff from staff#1 (S1) to staff #4 (S4), obtained food menu and elevator maintanence files; and conducted a facility tour.

Investigation revealed the following:
In regard of allegation, “staff do not afford residents in care with dignity and respect in their relationship,” it was alleged that staff speaks loudly to resident#1(R1) and enter R1's room without permission.
(-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: 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)

Page: 1 of 3

Control Number 28-AS-20230612152216

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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LPA interviewed residents. Eight (8) out of eight (8) residents could not corroborate the allegation. It revealed that staff would respect residents, speak with appropriate volume to ensure residents could hear staff clearly and knock on the doors before entering residents' room. R1 stated staff would speak up nicely to R1 and staff would knock on room's door asking for permission before entering. All interviewed staff denied the allegation. LPA observed staff who spoke with residents at the lobby did not talk loudly but residents would request staff to speak louder or repeat themselves to ensure residents could hear the conversation. During the facility tour, staff would knock on the residents' room doors asking for permission before entering. Thus, facility staff had afforded dignity and respect in their relationship with residents in care.

In regard of allegation, “staff do not prevent cigarette smoke from entering the facility,” it was alleged that residents smoke cigarette at the entrance door which cigarette smell entered the facility. LPA interviewed residents. Seven (7) out of eight (8) residents could not corroborate the allegation. It revealed that resident did not smell the cigarette smell at the entrance and the entrance doors were always close. R1 stated R1 had smelled cigarette smell when R1 was in the lobby. All staff interviewed denied the allegation. If staff smell cigarette at the entrance, staff would made sure the entrance doors were closed and requested residents who were smoking to go to the designated smoking area and stayed away from the entrance. Staff stated residents had personal right to smoke cigarette if they want to. LPA observed entrance doors were close during the visit. A sign "no smoking" was posted at the eye level on the wall near the entrance door. LPA did not smell cigarette smell at the entrance or lobby during the visit. Residents who smoke cigarette would go to the designated smoking area located at the back of the courtyard. Thus, facility staff did not fail to prevent cigarette smoke from entering the facility.

In regard of allegation, “facility is in disrepair,” it was alleged that R1’s room ceiling panels have fallen off and the slide glass door lock is broken. LPA interviewed residents. Seven (7) out of eight (8) residents could not corroborate the allegation. It revealed that their rooms were not in disrepair. R1 stated a piece of room ceiling panel was missing and the slide glass door lock was broken. All staff interviewed denied the allegation. LPA toured to R1's room and staff had been working on fixing it when administrator was aware of it. LPA tested the slide door lock and it was working. Thus, R1’s room is not in disrepair because R1’s room ceiling panel was in the process of repairing.

(-continued in LIC 9099C-)

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-20230612152216

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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In regard of allegation, “facility elevator is not working properly,” it was alleged that elevator near the kitchen would jerk when operating. LPA interviewed residents. Seven (7) out of eight (8) residents could not corroborate the allegation. It revealed that elevator near the kitchen would not jerk when operating. R1 stated elevator near the kitchen would jerk when operating. All staff interviewed denied the allegation. LPA took the elevator near the kitchen to go up and down to different floors. Elevator cargo would slightly pull up and pull down to level the cargo to the floor when it reached the floor. The elevator permit was valid with expiration date on 07/20/2023. The elevator company's last service was on 5/8/23. Thus, facility elevator is working properly.

In regard of allegation, “facility food is of poor quality,” it was alleged that facility food looks spoiled. LPA interviewed residents. Seven (7) out of eight (8) residents could not corroborate the allegation. Residents stated the food served at the facility is ok and did not look spoiled. Food served hot/ warm. R1 facility food looks spoiled. All staff interviewed denied the allegation. LPA observed residents’ meal and food did not look spoiled. Food was cooked fresh in the facility kitchen. Facility had a certified dietician to maintain facility’s food menus. Therefore, facility food is not of poor quality.

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 allegations are 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: 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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