198603401-5-3-2024-28-AS-FFIS-D5G2LV-20240520173010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 05/03/2024
Date Signed: 05/03/2024 04:28:58 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
04/30/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240430153135

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:	05/03/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Virgilio Agas, administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.
Staff did not prevent resident from being harassed in the facility.

INVESTIGATION FINDINGS:

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

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#8 (R8), interviewed staff from staff#1 (S1) to staff #6 (S6), and conducted a facility tour.

The investigation revealed the following:
In regard of allegation that staff did not safeguard resident's personal belongings, it was alleged that resident’s belongings were constantly being stolen in the facility. LPA interviewed residents, seven (7) out of eight (8) residents could not corroborate the allegation.

(-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: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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-20240430153135

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: 05/03/2024

NARRATIVE

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One (1) out of eight (8) residents stated resident had personal items, such as denture and slippers/sandals, were being stolen at the facility. All six (6) staff interviewed denied the allegation. Staff stated, instead of being stolen, residents’ personal belongings were misplaced in their rooms or being stored in their closets after washed. LPA conducted a physical plant and observed the resident who claimed to have belongings stolen, required a key to enter the resident’s room. A door charm would sound when the door being opened or closed. Per record review, the resident did not have record showing the possession of the claimed missing items. Thus, staff did not fail to safeguard resident’s personal belongings.

In regard of allegation that staff did not prevent resident from being harassed in the facility, it was alleged that the resident was being hit, harassed, and threatened at the facility. LPA interviewed residents, all eight (8) out of eight (8) residents could not corroborate the allegation. Residents interview revealed that residents were not being harassed at the facility. All six (6) staff interviewed denied the allegation. Staff stated facility staff was not allowed to harass residents. LPA observed staff were treating residents nicely. Thus, there was not preponderance of evidence to show staff harass residents while in care.

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: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

LIC9099 (FAS) - (06/04)

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