198603401-2-12-2024-28-AS-FFIS-D2HVRX-20240216154038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 01/02/2024
Date Signed: 02/12/2024 05:09:52 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
11/06/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20231106161243

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:	12:45 PM
MET WITH:	Gil Agas, administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff is financially abusing resident in care.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the original complaint investigation report created on 01/02/24. The finding had changed to 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 11/15/23, the initial investigation visit was conducted by LPAs Valeria Maldonado and Sanjay Vaid. LPAs interviewed staff from staff#1 (S1) to staff#4 (S4), obtained documents including residents/staff rosters, property insurance documents and resident#1 (R1) R1’s records.
On 01/02/24, LPA Tao conducted a subsequent visit. During the visit, LPA obtained copies of staff and resident rosters, interviewed residents from resident #2 (R2) through resident #5 (R5), attempted but failed to interview resident #1 (R1), obtained and reviewed resident #1 (R1) records, conducted a facility tour and delivered findings. (-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: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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-20231106161243

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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***This report serves as an amendment and supersedes the original complaint investigation report created on 01/02/24. The finding had changed to Unsubstantiated. ***

On 02/12/24, LPA Tao conducted another subsequent visit. During the visit, LPA obtained copies of staff and resident rosters, and delivered findings.

Investigation consisted of the following: interviews of staff from staff#1 (S1) to staff#4 (S4); interviews of residents from Resident#2 (R2) through Resident#5 (R5); attempted to interview resident #1(R1); reviewed resident#1’s record reviews, and a facility tour.

In regard of the allegation: staff is financially abusing resident in care, it was alleged that a resident damaged the facility’s entrance door and the facility charged resident for replacing the damaged door. The investigation revealed the following: LPA attempted to interview resident#1(R1), all attempts failed. All four (4) residents (R2-R5) interviewed could not corroborate the allegation. Resident interviews revealed that residents did not pay for repairing or replacing the damaged properties if they had broken any. Two (2) out of four (4) staff interviewed could not corroborate the allegation. Two (2) out of four (4) staff interviewed indicated a resident was advised to pay for replacing the damaged property since it was damaged by the resident's electric scooter. Per record review, a resident broke the entrance door in 2023 and made multiple small payments of a total of $270 to the facility for replacing it. Staff stated facility did not force resident to pay the full repairing cost but made payments at her own pace. Per review of the Admission Agreement and Electric Scooter Addendum, it stated residents were responsible for the cost of repairing the damaged facility property if the property was damaged by residents' electric scooters in the facility. Per facility’s property insurance coverages of 2023, the facility had insurance coverage for repairing the damaged property at the facility. Therefore, facility did not financially abuse resident.

Although the allegation may have happened or is valid, there’s not preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator, Gil Agas. A hard copy of this licensing report LIC 9099s was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231106161243

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/02/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 02/12/2024 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	Add'l Personal Rts of Res in Privately Operated Facilities (a)(8)To be free from neglect, financial exploitation.... This citation was dismissed. Complaint finding was amended and finding had changed to Unsubstantiated on 02/12/24.	1 2 3 4 5 6 7
	8 9 10 11 12 13 14		8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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