198603401-10-18-2024-28-AS-RORN-DB92EJ-20241121162000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 10/18/2024
Date Signed: 10/18/2024 12:21:42 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
10/14/2024 and conducted by Evaluator Sanjay Vaid

COMPLAINT CONTROL NUMBER: 28-AS-20241014095206

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: 89	DATE:	10/18/2024
		UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Gil Agas, Administrator		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Licensee is not ensuring that facility has running water.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid 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#1-11 (R1-R11), interviewed staff#1-3 (S1-S3), and conducted a facility tour with S2.
The investigation revealed the following:
In regard of allegation, licensee does not ensure that resident has running water, it was alleged that no water was delivered to residents’ bathrooms for showers and daily living needs due to no water at the facility. LPA interviewed residents and they stated water in resident’s bathroom was working just not delivering hot water. Three (3) out of three (3) Staff interviewed stated administrator had hired different technicians attempting to fix the hot water boiler on 10/04/24 (Friday), 10/05/24 (Saturday), running water.
Continued on page 9099C...............

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024

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-20241014095206

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: 10/18/2024

NARRATIVE

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10/07/24 (Monday) and would have technician to come on 10/09/24 (Wednesday) when parts were available. The facility had offered back up plan to accommodate residents’ showering needs. All the while facility had running water. Eleven (11) out of eleven (11) residents interviewed stated, the facility always has running water. The water was being delivered to residents’ bathrooms; just not hot water due to boiler breakdown on 10/04/24. Water was being delivered through-out the entire facility, for all the toilets, water taps and showers on the property. Three options were given to the residents; 1) Bed baths with sponge, 2) take to sister facility in Whittier for bathing, 3)boil water hot and then mix with cold to get warm water. Since the weather was hot due to the heat wave since last week, many residents were comfortable with cool water showers.
LPA Toa investigated complaint at the facility regarding; Licensee does not ensure that resident showers deliver hot water, which was substantiated.

Based on interviews conducted with staff and residents, and observed water running through the basin taps, toilet, and shower. The facility has had water always running at the facility. Based on the information obtained during the investigation, interviews with staff, residents, 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 copy this report was provided to Administrator at time of visit.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2024

LIC9099 (FAS) - (06/04)

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