198603401-9-3-2024-28-AS-RORN-D92QP9-20240912122023

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 09/03/2024
Date Signed: 09/03/2024 04:33:58 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
08/20/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240820101443

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: 90	DATE:	09/03/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Virgilio Agas, administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff left resident soiled in urine and feces for a period of time.

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:
LPA obtained staff / resident roster and resident#1’s (R1) records; interviewed residents from resident#2 (R2) to resident#8 (R8); attempted but unable to interview resident#1 (R1); interviewed staff from staff#1 (S1) to staff#4 (S4); and conducted a physical plant.

The investigation revealed the following:
In regard of allegation that staff left resident soiled in urine and feces for a period of time, it was alleged that staff did not change resident’s soiled diaper and the resident’s pressure wound got worse.
(-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: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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-20240820101443

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: 09/03/2024

NARRATIVE

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LPA interviewed residents, seven (7) out of eight (8) residents could not corroborate the allegation. One (1) out of eight (8) residents was unable to be interviewed. The resident interviews reviewed that staff would check on them every 2-3 hours and change their diapers when soiled. All four (4) staff interviewed denied the allegation. Staff interviews revealed staff would check on residents at least 3 times daily and change residents’ diapers as needed. Only one resident had pressure injures and that resident was under hospice care for resident’s pressure injuries. Staff stated that resident often refused cares from the Hospice nurses and facility staff. Residents had right to refuse cares. Staff would encourage that resident to accept cares from the staff and then staff would provide assistances on bathing/diaper changing to the resident. Per record review, the resident had often refused cares on changing diapers and bathing. Therefore, staff had assisted residents on diaper change, bathing assistance and pressure injuries 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: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC9099 (FAS) - (06/04)

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