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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 05/15/2025
Date Signed: 05/15/2025 02:49:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/06/2025 and conducted by Evaluator Mayra Cota
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250506090058
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: 72DATE:
05/15/2025
UNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Justin Lee, ManagerTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff threatened to illegally evict resident.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs), Mayra Cota and Blanca Gonzalez, conducted an initial unannounced complaint visit to investigate the above allegation. LPAs met with Justin Lee, Manager and explained the reason for the visit.

The investigation consisted of the following: LPAs, toured the common areas of the facility, obtained copies of relevant documentation, conducted interviews with Staff 1-Staff 2 (S1-S2) and Client 1 (C1).

Regarding: Faclity staff threatend to illegally evict resdient.

It is alleged that staff told C1 in a threating manner, C1 will be removed from the facility, implying C1 will be evicted.

***Continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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 2
Control Number 28-AS-20250506090058
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ARCADIA RETIREMENT VILLAGE
FACILITY NUMBER: 198603401
VISIT DATE: 05/15/2025
NARRATIVE
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The investigation revealed the following:

Interviews with S1-S2 revealed, they have not threatened to remove nor evict client. S1 stated, although they did discuss monthly rent payment policies with C1, they did not issue an eviction notice. S2 stated, they had a discussion with C1 regarding C1 ensuring their full rent portion is paid on time, however, S2 has not mentioned anything regarding a potential eviction nor issued an eviction notice to C1. Interview with C1 revealed, staff have not threatened nor have provided them with an eviction notice. C1 indicted they heard wrong and the incident didn't happen.



Based on record review and interviews conducted, the findings indicate, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Virgilio Agas, Administrator, and copy of the report was provided during visit.
SUPERVISOR'S NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mayra Cota
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
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