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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603445
Report Date: 01/12/2023
Date Signed: 01/12/2023 02:36:30 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
01/04/2023 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20230104090349
FACILITY NAME:ARCADIAN, THEFACILITY NUMBER:
198603445
ADMINISTRATOR:BRANCONIER, AMBERFACILITY TYPE:
740
ADDRESS:753 W DUARTE ROADTELEPHONE:
(626) 445-7981
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:120CENSUS: 93DATE:
01/12/2023
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Everlita Fernandez - Med Tech TIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff is physically abusing resident in care.
Staff is verbally abusing resident in care.
Staff leaves resident in diaper for an extended period of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Everlita Fernandez Med-Tech and explained the reason for the visit. Administrator Amber Branconier arrived an hour later.

The investigation consisted of the following: LPA requested a copy of staff/resident roster. LPA requested to review files for 9 residents and 5 staff. LPA conducted an interview with administrator and requested copies of resident #1(R1)'s physician report, face sheet, needs and care plan, assisted living waiver plan, admission agreement, medication sheet, facility notes, in addition LPA requested copies of police report investigation, and in-service training on topics; resident's personal rights and elderly abuse and neglect. LPA conducted interviews with 9 residents, and 4 staff. LPA attempted to speak with Arcadia police department's police officer and staff #6(S6).

(CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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-20230104090349
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: ARCADIAN, THE
FACILITY NUMBER: 198603445
VISIT DATE: 01/12/2023
NARRATIVE
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The investigation revealed the following: Regarding allegation: Staff is physically abusing resident in care. It is alleged staff possibly physical abuse R1 since severe bruises were notice on R1. Interviews conducted with residents revealed 6 out of 9 residents interview stated staff are respectful and have not been treated in a rough manner or in a manner that could have left bruises on them. 1 out of 9 residents stated there is a staff that can be rough when moving fast but has not left bruises, 1 out of 9 residents was unable to be interview due to cognitive skills and 1 out of 9 residents refused to be interview. Interviews with staff revealed 4 out of 4 staff interview stated they have not observed or heard residents state staff has physically abuse residents or hurt them. Administrator provided LPA information for a recent police visit to the facility regarding physical abuse involving R1 and explained that due to R1's medication is easily prompt to bruises and family and physician are aware of. Documents review revealed a visit by Arcadia Police Department officer was conducted on an APS report document not dated, per administrator the visit was conducted on 1/3/23, report #23-0040. During staff file review LPA did not observed warnings or write ups given to staff. Facility scheduled in-service training for staff throughout the year, Resident Rights training was provided on March 28th, 2022 and last Elderly Abuse and Neglect was provided on October 25th, 2022. Physician's note dated 1/4/23 notes R1 observed with bruises in both hands, common when taking blood thinner.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Staff is verbally abusing resident in care. It is alleged staff yelled at several residents. Interviews with 6 out of 9 residents revealed staff have not yelled at residents while in care. 1 out of 9 residents stated there is a staff that speaks loud, however staff is respectful when addressing the residents. 1 out of 9 residents was unable to be interview due to cognitive skills, and 1 out of 9 residents refused to be interview. 4 out of 4 staff interview stated staff speak to residents in a respectful manner and do not yell. Administrator stated there is a staff in the facility who speaks in a loud manner, but not in a misdemeanor manner. Documents review revealed a visit by Arcadia Police Department officer was conducted on an APS report document not dated, per administrator the visit was conducted on 1/3/23, report #23-0040. During staff file review LPA did not observed warnings or write ups given to staff. Facility scheduled in-service training for staff throughout the year, Resident Rights training was provided on March 28th, 2022 and last Elderly Abuse and Neglect was provided on October 25th, 2022.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230104090349
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: ARCADIAN, THE
FACILITY NUMBER: 198603445
VISIT DATE: 01/12/2023
NARRATIVE
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Regarding allegation: Staff leaves resident in diaper for an extended period of time. It is alleged residents are left without changing diapers for several hours at a time. Interviews with residents revealed 4 out of 9 residents interview stated staff changes resident as needed and have not been left throughout the day or overnight without a changing undergarments. 4 out of 9 residents interview stated that they do not require assistance with changing undergarment, however the staff ensure that they are dry and have not observe residents wet or heard other residents state they have not been assisted with changing undergarments. 1 out of 9 residents refused to be interview. Interviews with staff revealed 4 out of 4 staff interview stated that facility staff ensures residents are change undergarments as needed and ensure residents are dry and clean in each shift. 1 out of the 5 staff stated to not be familiar with changing schedules however has never observed residents or their beds wet or dirty. Administrator stated facility staff ensures residents are change as needed and are accountable in each shift. Documents review revealed R1's physician's report dated 5/25/22 notes R1 requires total assistance with incontinence care and toileting needs, assisted living waiver individual service plan dated 12/8/22 notes facility is to "check diaper as schedule and as needed." Facility does not maintain resident changing logs.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.


Exit interview was conducted with Amber Branconier Administrator and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3