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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603401
Report Date: 04/29/2025
Date Signed: 04/29/2025 10:31:15 AM

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
08/20/2024 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240820113413
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:
08:57 AM
MET WITH:Virgilio Agas - AdministratorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff did not prevent residents from using illegal drugs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores and Gabriela Castro conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPAs met with and explained the reason for the visit.

The investigation consisted of the following: On 8/20/24 LPA Tao conducted a health and safety check of the facility. Investigation Bureau (IB) department assigned the first allegation to investigator Heidy Bendana. On 11/5/24 LPA Tao conducted a subsequent complaint investigation visit, conducted a tour of the facility, and requested records pertaining to the investigation. On 11/19/24 LPA Tao conducted a subsequent complaint investigation visit, toured the facility, interviewed staff, and delivered findings for the second allegation. On 4/29/25 LPA Flores and Castro delivered findings for the above allegation.

(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
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 4
Control Number 28-AS-20240820113413
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
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The investigation revealed the following: Regarding allegation: Staff did not prevent residents from using illegal drugs. It is alleged residents at the facility are using and sharing illegal drugs, some have been hospitalized due to an overdose. Interviews conducted by IB investigator revealed the following, Administrator was aware of 5 residents using illegal drugs while in care. Administrator admitted, drugs were found in Resident’s #1(R1) room, they were turned into the police department for destruction. Administrator stated to have discussed evictions with residents. However, did not provided an eviction letter to R1. Per administrator residents are independent and therefore leave the facility. It is the administrator’s belief that is how the drugs are obtained and then distributed at the facility. Interviews with staff revealed some staff had knowledge that residents had drugs in their possession or had used illegal drugs while at the facility. Interviews conducted with residents revealed 3 out of 6 residents knew there was drug consumption within residents at the facility and 3 out of 6 stated to have not observed or know of drug use at the facility.

Documents reviewed revealed, on 7/30/24 Arcadia Police Department responded to the facility for a property report call. Upon police officer responding it was reported that plastic bags and containers with suspicious substances were found in R1’s room by a housekeeper. Officer used their expertise to check the substances and verified they were illegal drugs. Officer took the illegal drugs, weight them, and submitted them to evidence locker as property to be destroyed. Incident report dated: 7/30/24 notes R1 was send to the hospital after R1 was found in the room with facial injuries, which R1 reported were obtained by another resident due to drugs. Incident report dated: 7/30/24 notes R1’s room was being clean, illegal drugs were found, and police was contacted. Incident report dated: 8/12/24 notes Resident #2(R2) went to hospital themselves, and it was reported by the hospital R2 tested positive for illegal drugs. Facility also noted, to be aware of resident’s used of drugs. Incident report dated: 7/29/24 notes resident #4(R4) was taken to the hospital due to possible overdose. Per facility’s admission agreement alcohol and drug use policy, residents are encouraged to avoid use of alcohol and drugs outside the facility. Drunkenness and other maybe grounds for an eviction and the administrator reserves the right to confiscate illegal substances. Physician’s report reviewed for R1,R2, and R4 notes residents are able to leave the facility unattended. R1 has a history of substance abuse. Based on documents review, interviews conducted the facility staff has failed to take appropriate actions to address the residents use of drugs in the facility. Therefore, the allegation is substantiated.

(CONTINUED ON LIC 9099C)
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
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 4
Control Number 28-AS-20240820113413
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: 04/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/30/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents...: (a)... shall... personal rights: (4) To care, supervision,...that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by:
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Administrator will create a plan with steps which will include training, observations, documentation, process of eviction to prevent and that will be put in place upon suspicion or observations of illegal substance use per their policies and will submit a copy to the department by POC due date 4/30/25.
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Based on interviews and documentation reviewed administrator failed to follow their illegal substance policies which resulted on R1,R2, and R4 consuming illegal substances while in care which poses an immediate risk to the health, safety, or personal rights of the persons in care.
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Request Denied
Type A
04/30/2025
Section Cited
CCR
87405(b)
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87405 Administrator - Qualifications and Duties: (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee.
This requirement is not met as evidence by:
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Administrator will certify in writing that will ensure to follow through with the policies of the facility at all times and submit to the department by POC due date 4/30/25.
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Based on interviews and documents reviewed the administrator failed to proceed with their policy and note an eviction notice to R1 who had illegal drugs in their possession which poses an immediate risk to the health, safety, and personal rights of the 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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

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

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20240820113413
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
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Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted with Giselle Provencio Receptionist and a copy of this report, LIC 9099D, and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
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: 4 of 4