198603401-12-15-2021-28-AS-MVAO-CCSSDP-20220323134729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 12/15/2021
Date Signed: 12/15/2021 04:00:50 PM

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
12/10/2021 and conducted by Evaluator Nune Margaryan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211210163740

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: 66	DATE:	12/15/2021
		ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator VIirgilio, Agas		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident's room is unkempt.
Facility staff do not respond to resident's call for assistance in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced 10 day complaint visit to investigate the allegations listed above. Upon arriving at the facility, LPA met with Administrator Virgilio Agas who assisted with the visit. The reason for the visit was explained.

The investigation consisted of the following: LPA Margaryan inspected the facility including residents’ rooms, tested the signal system, obtained a copies of the staff roster, clients roster, other relevant documents and interviewed Administrator at 11:00 am, 3(three) staff and 8(eight) residents at 11:30am to 2:45pm.

The investigation revealed the following: Regarding allegation - Resident's room is unkempt. It was alleged that Resident #1 (R1’s) room observed to be dirty, stained, overflowing trash bags and dry cat food on the floor.

Continued 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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-20211210163740

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: 12/15/2021

NARRATIVE

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To investigate this allegation LPA Margaryan inspected the facility including residents’ rooms. The rooms appeared to be clean and trash cans were empty. R1’s room also was inspected. At the time of inspection LPA Margaryan observed housekeepers cleaning residents rooms.
LPA Margaryan interviewed Administrator and 3 (three) staff members. Interviews revealed that residents rooms, including R1’s bedroom, are cleaned every day. Housekeepers make the beds, pick up the trash, clean the floors and dust the furniture as needed. LPA observed that R1 has a cat. The cat makes a mess in the room and R1 is unable to clean after the cat. Staff checks the room few times a day and picks up the trash if needed.
LPA conducted an interview with 8 (eight) residents, including R1, and residents verified the information received from the staff. R1 also indicated that their room is being cleaned every day and it is messy sometimes because of their cat.
Based on the inspection, observation and interviews it was concluded that R1's room was clean, no trash in the room and no dry cat food on the floor.

Based on inspection, observation and interviews, there is no relevant information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

Regarding Allegation - Facility staff do not respond to resident's call for assistance in a timely manner. It was alleged that the Resident #1 (R1) needed assistance with toileting, and it took over an hour for someone to respond. To investigate this allegation with the assistance of the facility staff, LPA Margaryan inspected the facility including residents' rooms. During inspection, LPA tested an emergency call switch from the randomly selected rooms. Staff respond to the alarm within 2 -3 min. All interviewed residents reported that caregivers always answered the call switch in a timely manner. The longest time that the caregivers would usually take about 10 minutes. They do not have any issues with the emergency call switch. All interviewed staff denied the allegation. The staff usually responded the emergency call right away. The Administrator reported if the caregivers are busy with the residents, other staff in the facility would step in and help out too.

Based on inspection, observation and interviews, there is no relevant information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

Exit interview were contacted with the Administrator and copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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