198603401-3-15-2024-28-AS-FFIS-D483DY-20240410181018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 03/15/2024
Date Signed: 03/15/2024 12:26:39 PM

Substantiated

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
03/13/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240313094910

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:	03/15/2024
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Gil Agas, Administrator Justin Lee, assist administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Tao and Reyes conducted an unannounced complaint investigation for the allegation listed above. LPAs met Administrator, Gil Agas and Assisted Administrator, Justin Lee. LPAs explained the purpose of today's complaint investigation visit.

The investigation consisted of the following: LPAs obtained staff roster, resident roster, interviewed residents from resident#1 (R1) to resident#4 (R4), attempted to interview resident #5 (R5), interviewed staff from staff#1 (S1) to staff #2 (S2), and conducted a facility tour.

The investigation revealed the following:
In regard of allegation: facility is in disrepair, it was alleged that the facility’s central air condition (HVAC) system was not operational. LPAs interviewed residents, three (3) out of four (4) residents stated the HVAC was not cooling or not operational. One (1) out of four (4) residents stated the HVAC was operational.
(-continued in LIC9099C-)

Substantiated

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: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

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-20240313094910

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: 03/15/2024

NARRATIVE

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Per resident's interviews, administrator provided residents with portable ACs and heaters for those HVAC not working in their rooms. Two (2) staff interviewed stated about the HVAC was not working in about 20 residents’ rooms. LPAs toured the facility and observed the HVAC in four (4) resident's rooms were not operational which the HVAC was not cooling or not working. All of those rooms had portable AC and heaters to maintain residents' room with comfortable temperature.

Based on LPAs’ observations and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED.

Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8 on LIC 9099D.

An exit interview was conducted with administrator Gil. A hard copy of this report and appeal right were provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240313094910

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: 03/15/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/21/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	The facility shall be clean, safe, sanitary and in good repair at all times. The requirement is not met.	1 2 3 4 5 6 7	The facility central air condition (HVAC) is not cooling and operational in about 20 residents’ rooms.
	8 9 10 11 12 13 14	The facility central air condition (HVAC) is not cooling and operational in about 20 residents’ rooms. Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14	Licensee and assist administrator agreed to provide the repair/replace plan of the HVAC system by POC due date and follow up with Licensing regarding the progress of the repair/replace.
	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: 03/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024

LIC9099 (FAS) - (06/04)

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