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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 11/19/2024
Date Signed: 11/19/2024 05:56:42 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
10/18/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20241018140032
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: 82DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Gil Agas, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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7
8
9
Residents are being mislead and coerced to relocate to another facility.
An excluded individual is present in the facility.
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 10/25/24. The findings changed to substantiated. ***

Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced complaint investigation for the allegations listed above today. LPA met Administrator, Gil Agas and explained the purpose of today's visit.
On 10/25/24, the initial investigation visit was conducted. On 11/19/24, today, LPA Tao conducted a subsequent visit.

The investigation consisted of interviews with staff from staff#1 (S1) to staff#7 (S7); interviews with residents from resident#1 (R1) to resident#6 (R6); reviewed facility records; and conducted a physical plant.

(-continued on LIC 9099 C-)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 5
Control Number 28-AS-20241018140032
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: 11/19/2024
NARRATIVE
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***This report serves as an amendment and supersedes the original complaint investigation report created on 10/25/24. The findings changed to substantiated. ***

Regarding the allegation of residents are being misled and coerced to relocate to another facility, it was alleged that residents were misled into believing that they were required to be relocated to another facility after 12/31/24. The investigation revealed the following. All six (6) out of six (6) residents interviewed were corroborate the allegation. Resident interviews revealed that residents were confused and under a conception that they needed to move to another place after 12/31/24 due to the current licensee would loss control of the property. All seven (7) out of seven (7) staff interviewed were corroborate the allegation. Staff interviews indicated multiple residents had come to staff expressing residents’ concerns why they needed to move to other facilities. Per record review, the eviction notice stated the facility would assist residents’ relocation needs which did not indicate resident’s right of residing at the facility after 12/31/24. Therefore, the residents were misled to relocate to another facility.

Regarding the allegation of an excluded individual is present in the facility, it was alleged that an excluded person was presented at the facility. The investigation revealed the following. All residents interviewed could not corroborate the allegation because they did not know that excluded person. All seven (7) out of seven (7) staff interviewed were corroborate the allegation. Staff interviews indicated they had seen that excluded person showed up and walked around in the facility in multiple times. Therefore, an excluded individual had been presenting in the facility.

Based on review of documents and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 1. See LIC 9099D.

An exit interview was conducted with Administrator, Gil Agas. A hard copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
10/18/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20241018140032

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: 82DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Gil Agas, AdministratorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
An excluded individual is working as the licensee’s business partner.
Facility has no liability insurance.
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 10/25/24. The findings changed to un-substantiated. ***

Licensing Program Analyst (LPA) Tao conducted another subsequent unannounced complaint investigation for the allegations listed above today. LPA met Administrator, Gil Agas and explained the purpose of today's visit. On 10/25/24, the initial investigation visit was conducted. On 11/19/24, LPA Tao conducted a subsequent visit to investigate the allegation. On 11/26/24, LPA conducted another subsequent visit to otain administrator's signature for this LIC 9099 reports.

The investigation consisted of interviews with staff#1 (S1), staff#2 (S2), and Licensee; reviewed facility records; and conducted a physical plant.

(-continued on LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20241018140032
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: 11/19/2024
NARRATIVE
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2
3
4
5
6
7
8
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10
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12
13
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15
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***This report serves as an amendment and supersedes the original complaint investigation report created on 10/25/24. The findings changed to un-substantiated. ***

Regarding the allegation of an excluded individual is working as the licensee’s business partner, it was alleged the an excluded person was working as a business partner. Per interviews with Licensee Dr. Kang on 10/16/24 and 10/18/24, Licensee confirmed the excluded individual did not work as Licensee's business partner. Per the interviews with administrator and administrator assistant, they could not corroborate the allegation. Per record reviews, records did not show the excluded individual was working as Licensee's business partner. Therefore, there is not preponderance of evidence to prove the excluded individual is working as licensee's business partner.

Regarding the allegation of facility has no liability insurance, it was alleged that the facility did not have an active liability insurance coverage. Per record reviews, the facility had liablity insurance coverage with effective date started on 05/20/24 to 05/20/25. Therefore, the facility had a current liability insurance coverage.

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: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20241018140032
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: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/22/2024
Section Cited
CCR
87468.1(a)(3)
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(a) Residents in all residential care facilities for the elderly shall have..personal rights:(3)To be free from..intimidation

This requirement was not met by evidence of:
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6
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Licensee agreed to provide a written statement and ensure that the facility is in compliance with Title 22, section 87468.1(a)(3) requirements POC due.
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Per staff /residents interviews and record review, residents were misled and coerced to relocate to another facility. Licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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Type B
11/22/2024
Section Cited
CCR
87468.1(a)(2)
1
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(a) Residents in all residential care facilities for the elderly shall have..personal rights:(2) To be accorded safe... accommodations

This requirement was not met by evidence of:
1
2
3
4
5
6
7
Licensee agreed to provide a written statement and ensure that the facility is in compliance with Title 22, section 87468.1(a)(2) requirements POC due.
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9
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Per staff /residents interviews and record review, an excluded person was presented at the facility. Licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
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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: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5