198603824-6-8-2026-28-AS-LHIS-DVHTCE-20260629143635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603824
Report Date: 06/08/2026
Date Signed: 06/08/2026 06:17:10 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
06/01/2026 and conducted by Evaluator Bonnie Tao

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260601120023

FACILITY NAME:	ARCADIA RETIREMENT VILLAGE		FACILITY NUMBER:	198603824
ADMINISTRATOR:	ACHARYA, NIRJARA		FACILITY TYPE:	740
ADDRESS:	607 WEST DUARTE RD		TELEPHONE:	(626) 447-6070
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	200	CENSUS: 94	DATE:	06/08/2026
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Executive Director Paul (Apolinario) Gozon		TIME COMPLETED:	06:15 PM

ALLEGATION(S):

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Staff does not assist resident with transfer, resulting in resident being confined to bed.
Licensee does not ensure staffing is adequate to meet residents' needs.
Staff does not respond to resident's calls for help.
Staff does not ensure resident receives medical care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an initial complaint investigation visit for the allegations listed above. LPA met with the Executive Director Paul (Apolinario) Gozon. The purpose of today's visit was explained.

The investigation consisted of interviews of staff from staff#1 (S1) to staff#5 (S5), interviews of residents from resident#1 (R1) to resident#9 (R9), reviews of facility documents, and physical plant tour of the facility.

The investigation revealed the following:

In regard the allegation of facility staff does not assist resident with transfer, resulting in resident being confined to bed, it was alleged that resident did not get assistance to transfer from bed to wheelchair.
(-continued on LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2026

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-20260601120023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198603824
	VISIT DATE: 06/08/2026

NARRATIVE

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LPA interviewed nine (9) residents including residents who use wheelchairs and walkers. Per resident interviews, one (1) out of nine (9) residents interviewed stated staff did not assist resident to transfer from bed to wheelchair. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. Of those eight (8) residents, three (3) of them would need assistance with transferring and one (1) of them would need to use Hoyer Lift. They all received assistance as they needed. The other four (4) of them would not need assistance with transferring but would get it when they requested it. It revealed that staff would assist residents to transfer from beds to wheelchairs as needed.

Per staff interviews, all staff could not corroborate the allegation. Staff interviews revealed would provide assistance with transferring to residents as residents needed it. Per record review, staff were trained to use the Hoyer Lift and in-service training related to assist residents with transferring was provided to staff. Per LPA’s observation during the physical plant tour, staff were attentive to assist residents. Staff provided transferring assistance to residents to go to activities and dining room. Thus, the staff assist residents with assistance for transferring.

In regard the allegation of Licensee does not ensure staffing is adequate to meet residents' needs, it was alleged that the facility does not have sufficient staff to help residents with transferring needs. Per resident interviews, one (1) out of nine (9) residents interviewed stated the facility does not have enough staff to assist resident to transfer from bed to wheelchair. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. It revealed that residents got staff’s help when they needed it. Per staff interviews, all staff could not corroborate the allegation. Staff interview revealed that there are four (4) caregivers and one (1) med tech per AM and PM shift. There are two (2) caregivers and one (1) med tech during the night shift. Since the facility’s majority of residents were independent, not many residents need full care. Administrator stated the facility will employ additional caregivers by end of June since the resident census had increased. As staff stated, a resident preferred a particular staff to provide care and would decline other staff to assist. Therefore, it was not lack of staff but was a refusal to get staff’s assistance. Thus, there was not observed that the facility did not have adequate staffing.

(-continued on LIC 9099 C-)

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260601120023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARCADIA RETIREMENT VILLAGE	FACILITY NUMBER: 198603824
	VISIT DATE: 06/08/2026

NARRATIVE

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In regard the allegation of staff does not respond to resident's calls for help, it was alleged that the facility staff does not respond to residents’ calls in a timely manner. Per resident interviews, one (1) out of nine (9) residents interviewed stated staff did not respond to calls for assistance. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. It revealed staff would provide answer residents’ calls timely. Per staff interviews, all staff could not corroborate the allegation. Staff interview revealed staff would need to respond to residents’ calls as soon as possible, usually within 10 minutes, to provide assistance. Per LPA’s observation, LPA tested the call buttons multiple times from random resident’s rooms. The responding time was from 2 minutes to 8 minutes. Thus, the staff would respond to residents’ calls in a timely manner.

In regard the allegation of staff does not ensure resident receives medical care, it was alleged that the facility staff does not assist resident to go to doctor appointments for getting medical care. Per resident interviews, one (1) out of nine (9) residents interviewed stated staff did not assist the resident going to doctor appointment. Therefore, the resident was unable to get physician orders for medical equipment or treatments. Eight (8) out of nine (9) residents interviewed could not corroborate the allegation. It revealed that residents were able to get and see their doctors for treatments / medical cares. Per staff interviews, all staff could not corroborate the allegation. Staff interview revealed staff would keep track of residents’ appointments and follow up with their doctors for medical needs. Per record reviews, the resident who claimed that had not been seeing the doctor for months just had a doctor visit on the end of May. No additional medical equipment was stated on the physician notes. Thus, the staff had assisted the resident to receive medical care as needed.

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 Executive Director Paul (Apolinario) Gozon and findings were discussed. A copy of this report was provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2026

LIC9099 (FAS) - (06/04)

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