198603401-4-18-2024-28-AS-WSHO-D4SLZX-20240429091238

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 04/18/2024
Date Signed: 04/18/2024 03:27:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
04/17/2024 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240417135610

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: 79	DATE:	04/18/2024
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Virgilio "Gil" Agas - Administrator		TIME COMPLETED:	03:41 PM

ALLEGATION(S):

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Staff handled resident in a rough manner.
Staff does not treat residents with respect and dignity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met with Virgilio "Gil" Agas (Administrator) and explained the reason for the visit.

The investigatiion consisted of the following: LPA Mora requested for copies of the staff and resident rosters, and interviewed Administrator, Manager, Staff 1 - Staff 3 (S1 - S3), and Resident 1 - Resident 8 (R1 - R8).

Regarding the allegations "staff handled resident in a rough manne" and "staff does not treat residents with respect and dignity”, it is alleged that S1 insulted R1 by saying that R1 is fat and should not eat dessert during dinner and that S1 grabbed R2's legs, and roughly shook the legs telling R2 to get up for breakfast. Administrator stated these issues where brought up to him on 04/09/2024 and there is no witnesses or concrete evidence that it happened. It is all hearsay, but he still ended up giving S1 a write up. S1 denied the allegations. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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-20240417135610

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198603401
	VISIT DATE: 04/18/2024

NARRATIVE

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A total of 8 residents were interviewed. Resident 3 through Resident 8 could not corroborate the allegations. These residents described S1 as kind, respectful and gentle.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC9099 (FAS) - (06/04)

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