198603401-12-28-2023-28-AS-RORN-CZCMS2-20240110085111

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 12/28/2023
Date Signed: 12/28/2023 04:02:48 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
12/27/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20221227155327

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:	12/28/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Gil Agas, administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident is not provided transportation.
Facility is not following resident’s meal diet.
Facility has not provided assistance with medical care.
Facility does not have sufficient staff to meet resident’s needs.
Facility is not meeting resident's needs.
Resident is deny access to personal storage space.
Facility is not assisting resident with diabetic needs.

INVESTIGATION FINDINGS:

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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 12/29/22, LPA Tao conducted an initial investigation visit. LPA obtained staff / resident roster, and resident #1’s (R1) facility files. LPA Tao interviewed staff#1 (S1) and attempted but failed to interview resident#1 (R1). Due to insufficient information, that visit needed a further investigation.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #5 (S5); attempted interview of resident#1 (R1) and interviews of residents from Resident#2 (R2) through Resident #6 (R6); reviewed resident#1’s record reviews, and a facility tour. (-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: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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-20221227155327

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: 12/28/2023

NARRATIVE

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LPA obtained copies of the Staff and Resident Rosters; and resident files for Resident #1 (R1) with relevant information.

The investigation revealed the following:

In regards to the allegation of: resident is not provided transportation, it was alleged that the facility failed to provide transportation to resident as agreed prior to admission. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Resident interviews from R2 through R6 revealed that staff provided transportation to residents as they needed. All five (5) staff interviewed were denied the allegation. Per staff interviews, staff stated staff drove resident to grocery stores and banks multiple times as resident requested. Per record reviews, it indicated that resident declined to have “Access” transportation as staff attempted multiple times to assist resident for signing up for it. Thus, facility had provided transportation to resident.

In regards to the allegation of: facility is not following resident’s meal diet, it was alleged that staff failed to provide resident with renal and diabetic dietary needs. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Resident interviews from R2 through R6 revealed that staff provided meals per their dietary needs and the facility did not miss to serve them any meals. Food tray services were provided as needed or requested. All (5) staff interviewed had denied the allegation. Per staff interviews, staff stated administrator had specifically instructed dietary staff to follow resident’s dietary needs for resident’s renal and low sugar diet. Per observation, a A-4 size note was posted in the kitchen wall where food trays were prepared. That note indicated what food to serve or not to serve to that resident. As a result, the facility followed resident’s dietary needs.

In regards to the allegation of: facility has not provided assistance with medical care, it was alleged that resident did not get therapies at the facility. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Resident interviews from R2 through R6 revealed that therapies come to visit them as scheduled. All (5) staff interviewed had denied the allegation. (-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: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20221227155327

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: 12/28/2023

NARRATIVE

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Per staff interviews, administrator stated resident’s therapies visited resident at the facility a few times a week, not daily. Staff interviews revealed resident’s therapies had visited resident. Per record reviews, the resident was being forgetful prior admitting to the facility and had a pattern of forgetting his daily routine. Per file review, Administrator was closely working with resident’s representatives to ensure resident’s medical care were met. As a result, the facility had helped resident with medical care.

In regards to the allegation of: facility does not have sufficient staff to meet resident’s needs, it was alleged that facility did not have enough staff to provide care and respond to resident’s calls. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Resident interviews from R2 through R6 revealed that staff provided care to residents as they needed. Staff responded to residents’ calls in a few minutes. All five (5) staff interviewed had denied the allegation. Per staff interviews, staff had internal notes regarding residents’ needs and requests from each shift. Residents would verbalized their needs to staff. LPA tested the call/signal system and staff were able to respond to LPA’s calls in about 3 minutes and staff arrived at the residents’ rooms in about 10 minutes. Thus, there was not preponderance evidence showed facility did not have sufficient staff to provide care to residents.

In regards to the allegation of: facility is not meeting resident's needs, it was alleged the facility occasionally fail to provide dinner and assist resident with shower as scheduled. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Resident interviews from R2 through R6 revealed that staff provided meals and did not miss to serve them any meals. Residents were scheduled to shower twice or three times per week. All five (5) staff interviewed had denied the allegation. Staff stated resident was forgetful and could not recall the last shower even resident just had it an hour ago. Per record reviews, the staff had a log to keep track of providing care to residents and assistances. Therefore, there was not preponderance evidence showed facility did not meet resident’s needs.

(-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: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20221227155327

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: 12/28/2023

NARRATIVE

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In regards to the allegation of: resident is deny access to personal storage space, it was alleged that facility did not provide storage space to resident. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Resident interviews from R2 through R6 revealed that they have sufficient storage space in their rooms and additional storage rooms were provided as needed. All five (5) staff interviewed had denied the allegation. Per observation, resident’s personal properties were stored in resident’s room and an additional storage room. Thus, the facility had provided resident with personal storage space.

In regards to the allegation of: facility is not assisting resident with diabetic needs, it was alleged staff did not check resident’s sugar level daily and insulin was not provided as needed. Five (5) out of six (6) residents interviewed could not corroborate the allegation. Residents stated Med Tech checked residents’ sugar level and administered insulin as needed. All five (5) staff interviewed had denied the allegation. Staff stated resident was forgetful and could not recall whether resident had blood sugar checked or had insulin provided. Per record reviews, Med Tech had records to log residents’ blood sugar level and insulin injection on a daily basis. Thus, the facility had assisted resident with diabetic needs.

Although the allegations may have happened or is valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are 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. A hard copy of this reports were provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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