198603401-1-2-2024-28-AS-FFIS-CZAVJB-20240108152828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 01/02/2024
Date Signed: 01/02/2024 01:57:51 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
11/13/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20231113143730

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:	01/02/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Gil Agas, administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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

On 11/15/23, the initial investigation visit was conducted by LPAs Valeria Maldonado and Sanjay Vaid. LPA interviewed staff and obtained residents/staff rosters.

On 01/02/24, LPA Tao conducted a subsequent visit today. During the visit, LPA obtained copies of staff and resident rosters, interviewed residents from resident #1 (R1) through resident #4 (R4), reviewed resident #1 (R1) records, conducted a facility tour and delivered findings.

Investigation consisted of the following: interviews of staff from staff#1 (S1) to staff#4 (S4); interviews of residents from resident#1 (R1) through resident#4 (R4); and 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: 01/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

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-20231113143730

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: 01/02/2024

NARRATIVE

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In regard of the allegation: illegally evicted, it was alleged that the facility refused to accept the resident back after discharged from the hospital. The investigation revealed the following: All four (4) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents were not aware of any illegal eviction taking place at the facility. All four (4) staff interviewed denied the allegation. Per record review, resident was returned to the facility on 11/14/2023 after discharged from the hospital. LPA interviewed the resident at the facility during the visit. Resident indicated no eviction had taken place on the resident.

Although the allegation may have happened or is valid, there is not 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: 01/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024

LIC9099 (FAS) - (06/04)

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