198603401-2-12-2024-28-AS-FFIS-D2TVBZ-20240226151820

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 02/12/2024
Date Signed: 02/12/2024 05:06:12 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
02/06/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240206105545

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:	02/12/2024
		UNANNOUNCED	TIME BEGAN:	08:14 AM
MET WITH:	Virgilio Agas, administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's medication.
Staff did not maintain a comfortable temperature for a resident in care.

INVESTIGATION FINDINGS:

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

The investigation consisted of the following: during the investigation visit, LPA obtained staff roster, resident roster, resident#1’s (R1) records, interviewed residents from resident#1 (R1) to resident#6 (R6), interviewed staff from staff#1 (S1) to staff #6 (S6), and conducted a facility tour.

The investigation revealed the following:

In regard of allegation: staff did not safeguard resident's medication, it was alleged that resident’s January medications was missing from resident’s private room.
(-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: 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-20240206105545

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: 02/12/2024

NARRATIVE

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LPA interviewed residents, five (5) out of six (6) residents stated they did not have medication missing. One (1) out of six (6) residents stated resident had about 20 pills of prescribed medication short/missing in the bottle. All six (6) staff interviewed denied the allegation. Staff stated most residents stated they missed medication would be medication misplaced. LPA toured the facility and observed the resident who claimed resident’s medication missing was residing in a private room and the resident’s room required a key to enter the room. The prescribed medication was locked in a lock box in the resident’s private room and only the resident had the key to open the medication lock box. As the resident stated, the resident was self- responsible for own medication and administered own medication. Resident stated resident had never seen any staff taking resident’s medication from resident’s room. Per record review, staff had filed an incident report regarding resident’s missing medication and had followed up with resident. Thus, staff did not fail to safeguard resident’s medication.

In regard of allegation; staff did not maintain a comfortable temperature for a resident in care, it was alleged that the heater in resident’s room did not work and the portable heater did not work neither. LPA interviewed residents, five (5) out of six (6) residents stated their room had a comfortable temperature. They had operable portable heaters in their rooms besides the central heaters. One (1) out of six (6) residents stated resident’s room was cold. In additional, both facility’s central heater and portable heater were not working in resident’s room. All six (6) staff interviewed denied the allegation. Staff stated residents had additional portable heaters for residents’ use in their rooms. LPA toured the facility and observed the resident who claimed heaters were not working had an operable portable heater. The resident’s room had a comfortable temperature of 75 degree F. Per record review, staff had filed an incident report regarding resident’s requests on heaters. Staff had provided two different heaters to resident to choose in order to accommodate the resident’s needs. Thus, staff maintained a comfortable temperature for a resident.

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 allegation is 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: 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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