198603401-10-8-2024-28-AS-FFIS-DA9UU9-20241021155306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 10/08/2024
Date Signed: 10/08/2024 04:32:16 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
10/07/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20241007085019

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:	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:			TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Licensee does not ensure that resident showers deliver hot water.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegation listed above. LPA met Administrator, Gil Agas and explained the purpose of today's complaint investigation visit.

The investigation consisted of the following: during the investigation visit, LPA obtained staff roster, resident roster, interviewed resident#1 (R1), interviewed staff from staff#1 (S1) to staff #2 (S2), and conducted a facility tour.

The investigation revealed the following:

In regard of allegation, licensee does not ensure that resident showers deliver hot water, it was alleged that no hot water was delivered to residents’ bathrooms for showers. LPA interviewed resident, resident stated hot water in resident’s bathroom was not working for days. (-continued on 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: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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-20241007085019

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: 10/08/2024

NARRATIVE

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Since the weather was hot due to the heat wave since last week, resident was comfortable with cool water showers. Staff interviews revealed that water boiler was broken on 10/04/24 and administrator had taken immediate action to hire electricians and technicians to repair the facility water boiler. Administrator had tried to hire different technicians from different companies attempting to fix the water boiler immediately. Due to the delivery time of the replacement parts, the earliest time technicians could fix the water boiler would be 10/09/24. Administrator had notified residents about the hot water issues / updates by posting notices in the common areas and reported the hot water issue to Licensing with incident reports. The facility had offered back up plan to accommodate residents’ showering needs. LPA toured the facility and observed the notices posted in the common areas to inform residents about the hot water issue and updates. Per record review, administrator had hired different technicians attempting to fix the water boiler on 10/04/24 (Friday), 10/05/24 (Saturday), 10/07/24 (Monday) and would have technician to come on 10/09/24 (Wednesday) when parts were available. Even though the water boiler was broken for the last few days, the facility had taken immediate action to hire technicians to fix the boiler, notified residents, set up backup plan to accommodate residents’ needs and reported it to Licensing. Thus, administrator did not fail to ensure delivering hot water to residents for showers.

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: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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