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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603824
Report Date: 05/21/2026
Date Signed: 05/21/2026 09:41:25 AM

Substantiated


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
02/24/2026 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20260224120551
FACILITY NAME:ARCADIA RETIREMENT VILLAGEFACILITY NUMBER:
198603824
ADMINISTRATOR:ACHARYA, NIRJARAFACILITY TYPE:
740
ADDRESS:607 WEST DUARTE RDTELEPHONE:
(626) 447-6070
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:200CENSUS: 91DATE:
05/21/2026
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Paul GonzonTIME COMPLETED:
09:55 AM
ALLEGATION(S):
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Staff are not ensuring residents’ needs are being met.
INVESTIGATION FINDINGS:
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***This report supersedes report dated 05/09/2026. The purpose of this report is to correct the citation that was issued 11/22/2025 from HSC 1569.2(c)(4) to CCR 87464 (f)(4) all other findings remain the same. *** Licensing Program Analyst met with Paul Gonzon and explained the purpose of this visit.
Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Activity Assistant Martha Gonzalez who assisted with today’s visit. Administrator Paul Gonzon was notified via telephone.
The investigation consisted of the following: During the initial visit conducted on 03/03/2026, LPA Sanjay Vaid conducted an unannounced visit and obtained copies of the resident and staff rosters, documents for Resident #1, and six (6) random residents, resident shower schedules, resident shower refusal logs for February to present, monthly menus, and Interviewed Staff #1-#3 and Resident #1-#4. During today’s visit, LPA Gutierrez checked kitchen food supply, toured six (6) random resident bedrooms, obtained staff roster, resident roster, reviewed R1’s file and obtained copies of R1’s service plan, family meeting notes, and shower schedule. LPA also obtained facility food menu, resident council meeting notes, and requests from Administrator to email a copy of Aprils housekeeping schedule for all employees worked. LPA interviewed Administrator, staff #1-staff #8 (S1-S8), and residents# 1-residents #7 (R1-R7). During today’s visit LPA delivered findings.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
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 3
Control Number 28-AS-20260224120551
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: 05/21/2026
NARRATIVE
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In regard to the allegation” Staff are not ensuring residents’ needs are being met”, It is alleged that staff did not follow R1’s care plan for showering. During interviews with Administrator and staff two (2) staff stated that residents are getting showered according to their shower schedule .Two (2) staff indicated there are times that they miss scheduled showers because they are either short staffed or they don’t have clean towels During interviews with residents four (4) out of seven (7) stated that they do not need assistance with showers. One (1) R7 stated that he/she gets showered every day because that is there rights and they had assistance from CCLD to enforce that right. One (1) resident R1 stated they need to ask for showers and one (1) resident stated they ask for help occasionally and need to wait. During record review it was reviled that occurring to R1’s care plan they are to be showered twice a week, LPA obtained shower logs for the month of February and R1 should have been showered a total of eight times long indicated four showers, one refusal shower, and three missed showers from staff. LPA also collected notes from a meeting with facility staff and family dated 02/06/2026 indicating showers were to be given twice a week and two showers were missed after that meeting.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report and appeal rights were given to Martha Gonzalez.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20260224120551
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
05/16/2026
Section Cited
CCR
87464(f)(4)
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87464 Basic Services
(f) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.
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Administrator will develop a plan with all care staff to insure that shower schedule is followed and send plan to LPA by POC due date.
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Based on interviews and record review, the facility failed to follow R1's care plan for showers that resulted in 3 missed showers for the month of february which posed a potential personal rights risk to residents 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.
SUPERVISOR'S NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC9099 (FAS) - (06/04)
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