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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 09/17/2024
Date Signed: 09/17/2024 04:54:42 PM

Substantiated


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
09/12/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240912163809
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: 88DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Gisele Parvencio - Receptionist/Concierge TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee does not ensure facility is in good repair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial complaint visit to investigation the allegation listed above. LPA met with Gisele Parvencio, receptionist/concierge for the facility, and explained the purpose of the visit. LPA met with Justin Lee, Assistant Administrator, arrived shortly thereafter.

The investigation consisted of the following: During the visit, LPA interviewed Residents #1 - 11 (R1 - R11), Staff members #1 - 4 (S1 - S4), and also obtained the staff roster, client roster, conducted a tour of the facility including fifteen (15) resident bedrooms, the kitchen, and activity room.

The investigation revealed the following: In regards to the allegation that "Licensee does not ensure facility is in good repair," it is alleged that some of the resident rooms are in disrepair, which include leaks that are coming into the resident rooms through the ceiling due to air conditioning water drain pan overflowing, which has led to the facility having some rooms without ceiling panels and with buckets to collect the overflowing water, along with other fixtures including blinds that are in disrepair.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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-20240912163809
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: 09/17/2024
NARRATIVE
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During interviews with the residents, five (5) out of eleven (11) interviewed corroborated that the facility has rooms that are not in good repair. One staff interviewed stated that their room has water coming in through their ceiling with the due to the Air Conditioning (A/C) issues, and that the staff still have not fixed the pips, and the fixes that have been put in place are temporary fixes. Another resident interviewed stated that the facility frequently has plumbing problems as well which leads to toilets being clogged, and that repairs take a long time to be addressed by staff. Another resident explained that the charging outlet cover in their restroom is broken which is an electrical hazard, the towel rack in their restroom is broken, and their patio door that leads to the outside is always ajar and therefore wind constantly comes in through the room. During interviews with the staff, two (2) out of four (4) staff corroborated the allegation that there are some rooms that are in disrepair. One staff member explained that they are working on fixing the rooms that need repairs, and confirmed that the water pan drain has a leak which is leading to the leak in some of the resident rooms. Another staff interviewed stated that there are some rooms in the facility that do not have functioning A/C units. During the physical plant tour, LPA observed that there are several rooms in the facility that are in need of repairs. LPA will list the fixes that are required in resident bedrooms below:
  • Room #202 requires the A/C ceiling leak to be permanently fixed in the room, the ceiling panel needs to be replaced, and the blinds have rotting cord strings that are also in need of being replaced or fixed.
  • Room #212 requires the A/C ceiling leak to be permanently fixed in the room and its ceiling panel replaced.
  • Room #214 requires a functional A/C unit as it is not currently working.
  • Room #218 requires the A/C ceiling leak to be permanently fixed in the room and its ceiling panel replaced.
  • Room #305 requires the towel rack in its bathroom to be replace, it needs its charging outlet cover to be replaced as it is broken, and it also needs its smaller outdoor patio door to be fixed so that it closes fully, as it is currently slightly ajar when closed.
  • The carpets in all resident bedrooms will remain clean, sanitary, and in good repair at all times.

Based on LPA interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegations, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 is being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240912163809
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This regulation is not met as evidenced by:
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Administrator is to ensure that all resident bedrooms are to remain in clean, safe, sanitary, and in good repair at all times. Administrator is to make repairs to all the resident bedrooms that are identified on the LIC9099-C, and submit to LPA invoices for the repairs by the POC due date.
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Based on interview and observation, LPA determined that there are multiple leaks into residents rooms caused by overflows in the A/C water drain pan, which poses a potential health and safety risk to residents in care.
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Administrator will also submit LPA photographic proof of these fixes after they are made by email as well.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3