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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 04/29/2025
Date Signed: 04/29/2025 03:55:36 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
04/25/2025 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250425122734
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: 72DATE:
04/29/2025
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Virgillo Agas, AdministratorTIME COMPLETED:
03:58 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's toilet and tub is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alberto Lopez made initial unannounced visit to investigate the above allegation. LPA met with Gil Agas, Administrator and discussed the purpose of the visit.

The investigation consisted of LPA taking tour of facility, room 240, random rooms, obtaining and reviewing staff and residents rosters, Invoice from Drainflow and Solutions Plumbing dated 4/29/2025, Interviews with five (5) staff, seven (7) residents, and photos of phone text messages and outgoing calls.

The investigation revealed: Regarding allegation: Resident's toilet and tub is in disrepair. It is alleged that toilet is back up and sewage is seeping up into the bathtub due to the back up.


(continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
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 2
Control Number 28-AS-20250425122734
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: 04/29/2025
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
(continued from 9099)

LPA interviewed five (5) staff members, and all five (5) staff members stated they were aware of the toilet being clogged. S1 stated that the issue was brought to S1 attention on Friday 4/25/2025 at 2:00pm via text message and S1 asked resident to contact his manager because S1 was out sick. Phone records show that manager called plumbing company at 3:14pm on 04/25/2024 after being notified of clogged toilet. Plumbing company came in on 04/28/2025 and unclogged the toilet. LPA interviewed seven (7) residents and one (1) of seven (7) residents was able to corroborate the allegation. S1 stated that alternate room (236) was made available for resident to use in the meantime. Several staff corroborated the availability of alternate room for resident to use toilet and shower. There is insufficient evidence to substantiate this allegation as staff acting promptly and addressed the issue immediately.

Regarding allegation of medication missing from residents room. Staff and resident stated that resident is in charge of storing resident's medication. There is no evidence that medication was taken by staff. Resident was able to replace all medications as of today's visit.

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.

Exit interview conducted, a copy of the Appeal Rights and this report was provided to Virgilio “Gil” Agas

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2