<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:00:26 PM

Substantiated


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 VILLAGEFACILITY NUMBER:
198603401
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE RDTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 84DATE:
10/16/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Gil Agas, administratorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee does not ensure that resident showers deliver hot water.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
***This report serves as an amendment and supersedes the original complaint investigation report created on 10/08/24. The findings changed to substantiated. ***

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.

(-continued on LIC9099C-)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
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-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: 10/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***This report serves as an amendment and supersedes the original complaint investigation report created on 10/08/24. The findings changed to substantiated. ***

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. 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. The water boiler was broken for days and the entire facility had no hot water delivered to the residents' rooms.

Based on LPAs’ observations and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED.

Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8 on LIC 9099D. An exit interview was conducted with administrator Gil. A hard copy of this report and appeal right were provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2024
Section Cited
CCR
87303(e)(2)
1
2
3
4
5
6
7
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water.

This requirement was not met by evidence of:
1
2
3
4
5
6
7
Licensee agreed to repair the hot water by 10/13/24, POC due date.

The hot water was fixed on 10/13/24. POC is cleared.
8
9
10
11
12
13
14
Based on interviews and observation, the facility did not have hot water for days. Licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3