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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 06/13/2024
Date Signed: 06/13/2024 05:20:27 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
06/07/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20240607162537
FACILITY NAME:ARCADIA RETIREMENT VILLAGEFACILITY NUMBER:
198603401
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE RDTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 85DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Virgilio Agas, administratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff are not assisting resident with hygiene and hygiene supplies as needed.
Facility staff are not maintaining resident's room clean.
Facility staff are not providing food of the quality necessary.
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 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, facility staff are not assisting resident with hygiene and hygiene supplies as needed, it was alleged that staff did not bathe resident to maintain personal hygiene and provide hygiene supplies, such as toothpaste, towels or toilet paper, in resident’s room. LPA interviewed residents, seven (7) out of eight (8) residents could not corroborate the allegation. (-continued in LIC9099C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20240607162537
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: 06/13/2024
NARRATIVE
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One (1) out of eight (8) residents stated staff did not bathe resident because resident refused to be bathed. Residents stated they purchased their own toothpaste and toothbrushes, but towels, toilet papers and soaps were provided in the facility. All six (6) staff interviewed denied the allegation. Staff stated residents had a scheduled bathing day and residents had rights to refuse to be showered. LPA toured the facility and observed the residents’ rooms had hygiene supplies including towels, toilet papers and hand soaps. Per record review, resident had refused to take showers for multiple times over the months. The admission agreement did not indicate all hygiene supplies were provided by the facility upon admission. Thus, staff did not fail to bathe resident and provide hygiene supplies.

In regard of allegation, facility staff are not maintaining resident's room clean, it was alleged that resident’s room had blood smears on the wall, urine on the floor and flies in the room. LPA interviewed residents, seven (7) out of eight (8) residents could not corroborate the allegation. One (1) out of eight (8) residents stated resident did not allow staff to go into resident’s room because housekeeping would messy up resident’s room and the resident’s personal items would not arrange as resident preferred. All six (6) staff interviewed denied the allegation. Staff stated housekeeping would clean residents’ rooms daily. However, residents had rights and could decline to have their room cleaned. LPA toured the facility and observed the residents’ rooms were cleaned, no rotting food observed, no flies or pest in the rooms, no trash on the floor, beds were made, and bathrooms were cleaned. Thus, staff had maintained residents’ room clean.

In regard of allegation, facility staff are not providing food of the quality necessary, it was alleged that there were rotting food in resident’s room for resident to use. LPA interviewed residents, all eight (8) out of eight (8) residents could not corroborate the allegation. Resident stated residents could take their food trays and bring their purchased fruits into their rooms as preferred. Those overnight food trays or spoiled food were not for residents’ consumption. All six (6) staff interviewed denied the allegation. Staff stated staff would collect those food trays or spoiled fruits from residents’ rooms on the next day. Some residents might left those food trays and spoiled food under their beds for days and forgot about them. Then, staff had to search for those food and threw them away immediately. LPA toured the facility and observed no rotting food or fruits in any residents’ rooms. Thus, staff would throw away food items if those were not of the quality.

(-continued in LIC 9099C -)
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240607162537
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: 06/13/2024
NARRATIVE
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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.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3