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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 12/21/2023
Date Signed: 12/21/2023 02:00:28 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
07/21/2022 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220721085210
FACILITY NAME:ARCADIA RETIREMENT VILLAGEFACILITY NUMBER:
198603401
ADMINISTRATOR:VIRGILIO, AGASFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE RDTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 85DATE:
12/21/2023
UNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Virgilo "Gil" Agas - AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Resident fell while in care and staff did not provide timely assistance.
Staff handle residents in a rough manner and staff make inappropriate comments to residents.
Staff are not responding to residents call buttons.
Staff are not meeting residents needs.
Staff are not providing adequate food service to residents.
Staff are not providing residents with water.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent visit to investigate the above allegations. Upon arriving at the facility, LPA met Virgilo “Gil” Agas (Administrator) and the purpose of today’s visit was explained.

The investigation consisted of the following:
During the initial investigation conducted on 7-27-2022 LPA Kruz Long obtained a copy of the Staff/Resident Rosters and toured the kitchen with Agas Virgilio. Due to insufficient information available at the time, there was a need for further investigation.
During today's visit, LPA Herrera obtained a copy of the Staff/Resident rosters, copies of food menu, alternative food menu and holiday menu. LPA toured facility, tested call buttons in 6 resident rooms (1st, 2nd and 3rd floors tested), tour of kitchen and observed breakfast options. LPA interviewed 6 Staff and 10 Residents.
(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena HerreraTELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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 4
Control Number 28-AS-20220721085210
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: 12/21/2023
NARRATIVE
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The investigation revealed the following:

Allegation: Resident fell while in care and staff did not provide timely assistance.

It is alleged that R1 has witnessed a resident fall and it took staff a long time to assist the fallen resident. LPA interviewed 6 Staff and 6 out of 6 staff denied the above allegation and stated that when there is a resident fall they assist right away, if they are busy with a resident and cannot leave resident they are assisting right away they call to find someone immediately. LPA interviewed 10 Residents and 10 out of 10 residents denied the above allegation, 2 of the 10 residents interviewed stated they have experienced a fall and have been assisted right away, the other 8 residents interviewed stated that although they have not experienced a fall they feel confident that staff will assist right away.

Allegation: Staff handle residents in a rough manner and staff make inappropriate comments to residents.

It is alleged that R1 asked staff what’s for lunch and staff told R1 to “go to the office and find out yourself” and on another occasion staff said “We have other residents. You need to wait.” It is also alleged that staff were rough with R1 when assisting with their wheelchair as they have ran R1 into the table and their knee would get jammed, on another occasion staff mashed R1’s arm between the chair and the wall and hit R1’s feet on the table and walls. LPA interviewed 6 Staff and 6 out of 6 staff stated that they have never seen or heard of a staff rough handling residents or making inappropriate comments to residents. LPA interviewed 10 residents and 10 out of 10 residents denied the above allegation and stated that they have witnessed residents being disrespectful to staff but never the other way around. Residents stated that they feel safe at facility and are given dignity and respect.

(Continued on 9099-C)

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena HerreraTELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20220721085210
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: 12/21/2023
NARRATIVE
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Allegation: Staff are not responding to residents call buttons.
It is alleged R1 pushed the call button for staff assistance and no one arrived to assist until the next morning at 8am, and that the staff constantly ignore call buttons. LPA interviewed 6 staff and 6 out of 6 staff denied the above allegation and stated that responding to calls varies as the assigned caregiver may be busy assisting another resident but the wait is no more than 5-10 minutes (depending on the situation), if it is an emergency or something urgent staff respond right away. LPA interviewed 10 residents and 10 out of 10 residents denied the above allegation, they stated that sometimes the response may take a while depending on staff availability, however, if an emergency the staff responds quickly. Residents stated that the initial communication response time is immediate and depending on what the call is for is how quickly the staff will be able to assist as others may need priority assistance.
Allegation: Staff are not meeting residents needs.
It is alleged that R1 witnessed a resident in need of assistance with their Activities of Daily Living (ADL) and staff was nowhere to help. LPA interviewed 6 staff and 6 out of 6 staff denied the above allegation. Staff stated that there is a log that is followed and can change due to the need of the resident, staff also stated that rounds are conducted during beginning of shift to see what the needs of each resident assigned to them are and they assist accordingly. LPA interviewed 10 residents and 10 out of 10 residents denied the above allegation and stated that staff do the best they can. The residents that need assistance with ADL’s stated that they are provided the assistance daily and in a timely manner.
Allegation: Staff are not providing adequate food service to residents.
It is alleged that the food is terrible, everything is cooked on a grill and the food is served cold. LPA interviewed 6 staff and 6 out of 6 staff denied the above allegation, some stated that although the food can be better, they try their best to accommodate the residents and do the best they can. LPA reviewed the food menus and toured the kitchen, LPA observed breakfast being served which included multiple options and food supply appeared to be sufficient. LPA interviewed 10 residents and 8 out of 10 residents denied the above allegation and stated the food is ok and they receive 3 meals daily with a full menu and alternate menu. Residents stated that although the food could taste better, they feel the meals are decent and fulfilling. (Continued on 9099-C)
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena HerreraTELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20220721085210
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: 12/21/2023
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Allegation: Staff are not providing residents with water.
It is alleged that the staff does not provide water to residents when they need it, and fail to provide water while taking medication. LPA toured facility and observed water supply in dining/kitchen to be sufficient, the water dispenser for hot/cold water was observed to be in working condition, LPA observed additional water supply in large manual water dispensers on 2nd and 3rd floors to be filled with clean water and available to residents. LPA interviewed 6 staff and 6 out of 6 staff denied the above allegation and stated that there is always water available to residents, the dispensers are filled throughout the day, residents can request to have pitchers of water with ice delivered to their rooms and water is always readily available during medication time. LPA interviewed 10 residents and 10 out of 10 residents denied the above allegation and stated they always are provided water when taking their medication, residents also stated they have never had issues getting water, dispensers have all remained in working condition and they are able to have pitchers of ice water delivered to their rooms.
Allegation: Facility is in disrepair.
It is alleged that the Air Conditioner (A/C), water machine, and dishwasher are not working. LPA toured facility and A/C, electrical water dispenser and dishwasher were all in working order. LPA interviewed 6 staff and 6 out of 6 staff denied the above allegation. S1 stated that if at any point the A/C is not working they will make accommodations, weather it be adding a fan to the room, portable A/C or relocating resident until repair is made. LPA interviewed 10 residents and 10 out of 10 residents denied the above allegation and stated that they have not noticed anything at the facility being in disrepair. Some residents mentioned a light bulb being out or a towel rack loose but that repairs were made in a timely manner.
- Based on statements and interviews conducted with staff and residents, review of facility file records, and LPA's observations, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
- Exit interview held, and a copy of this report will be emailed to Virgilo Agas.
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena HerreraTELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4