198603401-1-28-2025-28-AS-FFIS-DDKU5H-20250204141644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 01/28/2025
Date Signed: 01/28/2025 03:24:12 PM

Unsubstantiated

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
12/20/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20241220164541

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: 75	DATE:	01/28/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Virgilio Agas, administrator, and Justin Lee, administrator assistant		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident’s carpet and flooring are in disrepair affecting resident’s mobility.
Staff do not ensure that resident has hot water.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the original complaint investigation report created on 12/24/24. The findings changed to un-substantiated. ***

Licensing Program Analysts (LPAs) Tao and DeLeon conducted a subsequent unannounced complaint investigation for the allegations listed above. LPAs met with Gil, Administrator and Justin Lee, administrator assistant. The purpose of today's visit was explained.

On 12/23/24, LPA Tao conducted the initial investigation visit. On 12/24/24, LPA Tao conducted a subsequent visit. On 01/28/25, LPAs Tao and DeLeon conducted another subsequent visit to deliver findings.

(-continued in 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: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

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-20241220164541

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: 01/28/2025

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 12/24/24. The findings changed to un-substantiated. ***

The investigation consisted of staff interviews from staff#1 (S1) to staff#2 (S2), resident interviews from resident#1 (R1) to resident#3 (R3) and conducted a physical plant in R1/ R2’s rooms. Copies of staff and resident rosters were obtained.

The investigation revealed the following:

In regard the allegation of staff do not ensure that resident has hot water, it was alleged that hot water was not delivered to residents’ bathrooms for showers on a regular basis. LPA interviewed resident#1(R1), the interview revealed hot water was delivered to resident’s bathroom and the water temperature was above 120 degree F. Staff interviews revealed that a new water boiler was installed, and the thermostat was set to a range from 115 degree F to 120 degree F. LPA toured the facility and tested the water temperature in residents’ rooms. The water was measured from 123.8 degree F to 125 degree F. Thus, staff did not fail to ensure hot water was delivered to residents for showers.

In regard the allegation of resident’s carpet and flooring are in disrepair affecting resident’s mobility, it was alleged that the carpet in resident’s room was dirty and the flooring in resident’s bathroom was in disrepair which affected resident’s mobility in the room. LPA interviewed resident#1, the interview revealed the room carpet had black stains/spots. Per staff interviews, staff denied the allegation. LPA conducted a physical plant and observed the resident’s room had stain /spots on the carpet and the resident’s bathroom had broken vinyl flooring at the entrance area. However, resident’s mobility was not observed to be affected by the dirty carpet and bathroom flooring.

LPAs will conduct a separate case management regarding the hot water and the resident’s room in disrepair.

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.

(-continued in LIC 9099 C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20241220164541

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: 01/28/2025

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 12/24/24. The findings changed to un-substantiated. ***

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 allegations are UNSUBSTANTIATED.

An exit interview was conducted with Administrator Gil and findings were discussed. A copy this report was provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC9099 (FAS) - (06/04)

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