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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 12/03/2024
Date Signed: 12/03/2024 03:36:26 PM

Substantiated


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
11/25/2024 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241125082117
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: 81DATE:
12/03/2024
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Virgilio Agas - AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not delivering hot water for residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bennette Pena conducted an initial 10-day complaint investigation visit regarding the above allegation. LPA met with Administrator Virgilio Agas.and discussed the purpose of the visit.

The investigation consisted of: LPA obtained copies of the staff & resident rosters, Resident #1 (R1) files such as: Admission Agreement, Physician's Report, Functional Capability Assessment, Identification and Emergency Information (Face sheet) and Unusual Incident/Injury Reports (Oct. 2024). Between 10:15am-12:30pm, LPA interviewed Staff #1 (S1) - Staff # 5 (S5) and Resident #1 (R1)-Resident #15 (R15). Between 12:30pm-1:30pm, LPA toured the interior common areas, residents rooms and conducted water temperature check on random residents’ rooms in the 1st, 2nd and 3rd floors (Rooms: #106, #113, #115, #203, #208, #210, #211, #213, #216, #218, #228, #230, #239, #305 and #307).*****CONTINUED ON LIC9099-C*****.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
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-20241125082117
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: 12/03/2024
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
The investigation revealed the following:

In regards to the allegation:"Facility is not delivering hot water for residents in care." It is alleged that the facility has been without hot water since Nov. 19, 2024 and continued as of Nov.22, 2024. It is also alleged that the facility experienced hot water outages in October 2024 and during the second week of November 2024. (5) out of (5) staff interviewed stated that there was no hot water in the facility around the 2nd and 3rd week of November 2024 due to the repairs done with the leaking pipes and broken hot water pump. S2 stated that during that time, staff had to turn the hot water off while the plumbing work was being done. S1-S2 stated that it took a few days before it got fixed due to parts availability. Staff interviewed indicated that the hot water issue is now fixed and S1 provided a copy of the work order invoices (Oct.-Nov.2024). (13) out of (15) residents interviewed confirmed that there was no hot water sometime in October 2024 and for almost a week around the 2nd week through the 3rd week of November 2024. Some residents interviewed stated that they felt uncomfortable because the availability of hot water has been on and off. All residents interviewed stated that they now have hot water. During the visit, LPA randomly tested the hot water in (15) resident rooms and temperature measured within 105-120 deg. F which is within Title 22 regulations requirement.

Based on observation, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency is being cited according to Title 22. See LIC 9099D.

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

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20241125082117
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/03/2024
Section Cited
CCR
87303(e)(2)
1
2
3
4
5
6
7
87303 Maintenance and Operation.. (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
During the visit, hot water is available to the residents rooms. Administrator agreed to continue to monitor the boiler system and to contact a technician immediately if the hot water system is not working. ***DEFICIENCY CLEARED DURING THE VISIT.***
8
9
10
11
12
13
14
Based on observation and interviews, the Administrator did not comply with the section cited above in which the facility did not have hot water for days between 2nd week through the end of November 2024 which poses an immediate health, safety or personal rights risk to residents 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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3