198603401-11-14-2024-28-AS-RORN-DB8P5X-20241121100127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 11/14/2024
Date Signed: 11/14/2024 02:48:42 PM

Unsubstantiated

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
11/05/2024 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241105114802

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: 82	DATE:	11/14/2024
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Virgilio Agas - Administrator		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff did not treat resident with dignity and respect.
Staff did not provide resident with copy of personal rights.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit to
investigate the above allegations. LPA met with Virgilio Agas, Administrator and discussed the
purpose of the visit.

The investigation consisted of the following: LPA obtained copies of the Resident & Staff Rosters, Staff In-service training logs for Suspected Abuse/Mandated Reporting, Resident's Personal Rights and Zero Tolerance Policy and Minutes of the Resident Council Meeting (08/06/2024 & 10/08/2024). LPA also obtained Resident #1 (R1) files such as: Face sheet, Admission's Agreement, Physician's Report, Preplacement Appraisal, Personal Rights, Resident Assessment and Unusual Incident/Injury Reports (June 2024-Nov. 2024). LPA interviewed Resident #1 (R1) telephonically on 11/13/2024. During today's visit, LPA interviewed Staff #1 (S1) - Staff #4 (S4) and Resident #2 (R2) - Resident #9 (R9).

The investigation revealed the following:
In regards to the allegation: “Staff did not treat resident with dignity and respect.” It is alleged that R1 felt embarrassed and humiliated because S1 was shouting at R1 in the presence of other residents. It is also alleged that S1 and S2 become aggressive when speaking to the residents. *****REPORT CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

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-20241105114802

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: 11/14/2024

NARRATIVE

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S1 denied the allegation and stated that he never yelled, humiliated nor acted aggressively to any residents. S1 stated that the facility has zero tolerance policy with that type of behavior. All staff members interviewed stated that they never heard or witnessed any staff shouting or being aggressive to R1 or any residents. Staff members also stated that they always treat residents with dignity and respect. Staff members indicated that they receive in service training regarding personal rights, zero tolerance and mandated reporting. (8) out of (9) residents that were interviewed stated that staff members treat them with dignity and respect. Interviewed residents stated that staff members are nice, patience and respectful to them. During the visit, LPA did not observe staff being loud or speaking in loud voices. LPA was not provided with proof that S1 was shouting at R1 in the presence of other residents and there were no other witnesses to the alleged incident. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation: “Staff did not provide resident with copy of personal rights.” It is alleged that R1 never received a copy of his personal rights. S1 stated that during admission, resident and responsible party were advised and given a copy of their personal rights. S1 stated that each resident signs a copy of the personal rights and the signed copy is included in the resident's record. Additionally, resident and responsible party sign an acknowledgement that they received it. S1 also stated that personal rights are discussed primarily during the monthly resident council meeting because they are an important topic. Some staff members interviewed indicated that a copy of their personal rights are automatically given to the residents upon admission but if they lost it or need another copy, it will be provided if requested. (8) out of (9) residents that were interviewed stated that they know their personal rights and the residents personal rights is posted on the wall in the hallway. (3) out of (9) residents interviewed stated that they just asked for a copy of their personal rights recently and the staff provided it to them right away. During the visit, LPA observed that the personal rights written in English and Spanish are posted in the hallway near the lobby and accessible to the residents and the public. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Virgilio Agas.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

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