198603824-6-10-2026-28-AS-FFIS-DVMTVX-20260703150441

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603824
Report Date: 06/09/2026
Date Signed: 06/10/2026 08:54:07 AM

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
01/30/2026 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260130103652

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:	06/09/2026
		UNANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Executive Director, Apolinario Gozon		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff are not allowing resident to review the admission agreement prior to signing
Staff did not provide resident with the Admissions Agreement fee schedule for additional services
Staff are not meeting resident's laundry needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vaid conducted subsequential visit to the facility and met with Executive Director, Apolinario Gozon and discussed the reason for the visit. Obtained staff and residents rosters. LPA Vaid interviewed staff and residents for the above-mentioned allegations. LPA Vaid obtained and reviewed the housekeeping and laundry schedules.

On 02/02/2026, LPA Vaid met with Resident Services Director Brook Lamotte and Operation Director/ Administrator Lisa Pham. LPA Vaid requested and obtained the following documents: LIC 500 dated 02/02/26, resident roster dated February 2026. R1-R5 face sheet, physicians report, Individual Service Plan, admissions agreement with fee schedule for additional services for private and Assisted Living Waiver, monthly staff laundry schedule. Ombudsman contact information.

The investigation revealed the following:

CONTINUED ON PAGE 9099C..................

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

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-20260130103652

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: 06/09/2026

NARRATIVE

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Regarding the allegation: Staff are not allowing residents to review the admission agreement prior to signing. It is alleged that the staff are not allowing residents to review the contents and thoroughly read the admissions agreement and are rushing the resident to sign the documents immediately. Five of five staff interviewed denied this allegation, staff stated the residents were all given a copy of the admissions agreement on 12/01/2025 when the new ownership took possession of the facility. LPA interviewed Staff who communicated with all residents regarding the new admission agreement due to the change of ownership. Per staff, they met with each resident and/or their responsible parties to review and sign the new admission agreement. Staff stated that they attempted to meet with R1 to review the document. However, R1 did not allow the staff any opportunity to go over the new contract and told staff that R1 will not sign it. Staff also stated that R1 was provided with another copy of the admission agreement upon request. LPA obtained a copy of the new admission agreement that was provided to R1. The contract appeared complete and indicated the residents’ name and charges. LPA interviewed R1 who stated that the staff only provided a copy of the blank admission agreement and told resident to sign the documents immediately. Staff stated that they have attempted to meet with R1 to review the document. However, R1 has not allowed the staff any opportunity to go over the new contract and has told staff that R1 will not sign admissions agreement. Staff also stated that R1 was provided with second (2nd) copy of the admission agreement upon request and third (3rd) copy on 01/06/2026. Eight of nine residents interviewed stated that the staff met with them to go over the new admission agreement and provided the rates. Based on records reviewed and interviews conducted, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated.

Regarding the allegation: Staff did not provide resident with the Admissions Agreement fee schedule for additional services. It is alleged that the staff are not providing resident with a fee schedule for extra services. Five of five staff interviewed denied this allegation, LPA interviewed Staff who met with residents and their responsible parties to review, discuss the admissions agreement and fee schedules for extra services (incontinent program, escort to physicians’ office, guest meals, emergency pendant replacement) and sign the admissions agreement. Staff stated that they have attempted to meet with R1 to review the document. However, R1 has not allowed the staff any opportunity to go over the new contract and has told staff that R1 will not sign admissions agreement. Staff also stated that R1 was provided with second (2nd) copy of the admission agreement upon request and third (3rd) copy on 01/06/2026. LPA obtained a copy of the new admission agreement that was provided to R1. The contract appeared complete and indicated the residents’ name and charges. Eight of nine residents interviewed stated that staff met with them and discussed the extra services provided and the service fees.
CONTINUED ON PAGE 9099C.................

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260130103652

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: 06/09/2026

NARRATIVE

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R1’s fee schedule shows zero dollars for the extra services, R1 is charged a single monthly fee for their room rental with housekeeping and laundry services being included. Based on records reviewed and interviews conducted, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated.

Regarding the allegation: Staff are not meeting residents’ laundry needs. It is alleged that the staff are not meeting the resident’s laundry needs and staff are not being completed on residents assigned day. Five of five staff deny this allegation, according to the resident laundry schedule, R1 receives laundry services one day per week as scheduled. LPA interviewed staff who provide residents with laundry services, staff stated they sort, wash, dry , fold and hang residents clothes. According to the staff the goal is to keep the residents’ rooms from developing foul odor from dirty laundry accumulating in residents room. Eight of nine residents interviewed stated the staff provides laundry services on their scheduled days and will wash soiled bed linen as needed. R1 stated being independent and doing their own laundry. According to R1’s residents care summary, R1 has only elected additional services assistance with the housekeeping and to provide daily tidying up and trash removal. The staff stated they are ready to assist R1 should R1 require laundry services. Based on records reviewed and interviews conducted, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated.

An exit interview was conducted and copy of this report was given to Executive Director, Apolinario Gozon.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026

LIC9099 (FAS) - (06/04)

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