198603445-4-11-2024-28-AS-RORN-D4UMLB-20240501094200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603445
Report Date: 04/11/2024
Date Signed: 04/11/2024 06:08:42 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/17/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220317135152

FACILITY NAME:	ARCADIAN, THE		FACILITY NUMBER:	198603445
ADMINISTRATOR:	STARNES, CINDI		FACILITY TYPE:	740
ADDRESS:	753 W DUARTE ROAD		TELEPHONE:	(626) 445-7981
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	120	CENSUS: 95	DATE:	04/11/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Amber Branconier, Licensee		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained a hematoma while in care.
Staff did not provide adequate supervision.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Bonnie Tao and Tyler Reyes conducted a subsequent complaint visit regarding the allegation listed above. LPAs Tao and Reyes met with Staff#9 (S9) and Licensee, Amber Branconier and discussed the purpose of the visit, which was to continue the investigation and deliver complaint investigation findings.

On 03/18/2022, LPA Tao conducted the initial visit, during visit, LPA obtained a copy of staff roster, resident roster, Resident #1 (R1) and Resident #8 (R8) facility file, facility house rules and R1’s incident reports relating to falls. LPA toured the physical plant, along with Office manager and did not observe any signs of neglect, abuse or other immediate health and safety threats.

On todays visit, LPA Tao and Reyes interviewed Administrator, staff, and residents, and toured the physical plant with staff#9 (S9).

(-continued in LIC 9099C-)

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

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 6

Control Number 28-AS-20220317135152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARCADIAN, THE	FACILITY NUMBER: 198603445
	VISIT DATE: 04/11/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding allegation: Resident sustained a hematoma while in care. It is alleged that a resident fell twice in the facility and was hospitalized for two days after the second fall, upon return to facility, a resident was placed in a seat belt for fall prevention; however, staff failed to secure the resident’s seat belt, resulting in a subsequent fall causing serious injury to resident.
The investigation consisted of the following. Per resident interviews, seven (7) out of seven (7) residents could not corroborate the allegation and revealed they were not aware of any resident sustain of hematoma. R1 was not interviewed due to R1’s medical condition. Per staff interviews, seven (7) out of nine (9) staff revealed that staff were aware R1 had fallen in the facility and two (2) of nine (9) staff denied knowledge that R1 fell in the facility. Eight (8) of nine (9) staff reported there was adequate care and supervision provided at the facility. One (1) of nine (9) staff reported staff left R1 alone and R1 sustained a fall. Review of incident report dated 08/24/21, indicated R1 fell in the facility and was taken for the hospital for medical treatment, and discharged to a Rehab for continued care. Review of 09/23/21 incident report, indicated R1 fell in the facility a second time and was sent to hospital for medical treatment. The facility notified the department of R1 falls in a timely manner. On 08/24/21 around 11PM, R1 fell in the facility and was transferred to the hospital on 08/24/21 for medical treatment, R1 was discharge from the hospital on 08/25/21 and returned to the facility; however, R1 complained of pain and was sent back to the hospital on 08/25/21. R1 sustained a right shoulder fracture and subdural hematoma. On 08/31/21, R1 was transferred to different hospital for rehabilitation. On 09/15/21, R1 returned to the facility. On 09/23/21, R1 sustained a subsequent fall in the facility while sitting in R1 wheelchair. R1 was transported to the hospital on 09/23/21 for medical treatment. R1 hospital records, dated 09/23/21, indicated R1 sustained an acute on chronic bilateral subdural hematoma.

Therefore, the investigation revealed the facility did not conduct a reappraisal of R1’s fall risk after R1 fell in the facility on 08/24/21; the facility did not update R1 care plan for fall prevention; R1 sustained a fall on 08/24/21 resulting in injury and sustained a subsequent fall on 09/23/21, which resulted in R1 sustaining injury/aggravation to R1’s previous injuries.

Regarding allegation: Staff did not provide adequate supervision. It is alleged that a resident fell three times in the facility. Resident was hospitalized after the second fall for two days and returned to the facility, however, due to staff not providing adequate supervision, the resident sustained a third fall.
(-continued in LIC 9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 28-AS-20220317135152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARCADIAN, THE	FACILITY NUMBER: 198603445
	VISIT DATE: 04/11/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation consisted of the following. Per resident interviews, seven (7) out of seven (7) residents could not corroborate the allegation and revealed they were not aware of any resident fall at the facility and residents stated staff treated them fine. R1 was not interviewed due to R1’s medical condition. As mentioned above, per staff interviews, seven (7) out of nine (9) staff revealed that staff were aware R1 had fallen in the facility and two (2) of nine (9) staff denied knowledge that R1 fell in the facility. Eight (8) of nine (9) staff reported there was adequate care and supervision provided at the facility. One (1) of nine (9) staff reported staff left R1 alone and R1 sustained a fall. Review of incident report dated 08/24/21, indicated R1 fell in the facility and was taken for the hospital for medical treatment, and discharged to a Rehab for continued care. Review of 09/23/21 incident report indicated R1 fell in the facility a second time and was sent to hospital for medical treatment. The facility notified the department of R1 falls in a timely manner.
The investigation revealed, on 08/24/21 around 11PM, R1 fell in the facility and was transferred to the hospital on 08/24/21 for medical treatment, R1 was discharge from the hospital on 08/25/21 and returned to the facility; however, R1 complained of pain and was sent back to the hospital on 08/25/21. R1 sustained a right shoulder fracture and subdural hematoma. On 08/31/21, R1 was transferred to different hospital for rehabilitation. On 09/15/21, R1 returned to the facility. On 09/23/21, R1 sustained a subsequent fall in the facility while sitting in R1 wheelchair. R1 was transported to the hospital on 09/23/21 for medical treatment, R1 hospital records dated 09/23/21, indicate, R1 sustained an acute on chronic bilateral subdural hematoma. Therefore, the investigation revealed the facility did not provide adequate care and supervision to R1, resulting in R1 sustaining multiple falls on 08/24/21 and 09/23/21, both falls resulted in R1 sustaining injury. Additionally, the facility failed to conduct a reappraisal to R1’s fall risk after R1 fell in the facility on 08/24/21 and did not update R1 care plan for fall prevention.

Based on interviews conducted and documents reviewed, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, and Chapter 8), are being cited on the attached LIC 9099D.

An immediate $500 civil penalty is being issued during today's visit due to the neglect/lack of care and supervision resulting in resident sustaining serious injuries.

The licensee was informed that a civil penalty might be assessed based on the Health & Safety Code 1569.49(e) or (f), or 1548(e) or (f), or 1568.0822(e) or (f).
Exit interview conducted with Amber, Licensee. Appeal Rights were discussed and a copy of Licensing Report and Appeal Rights were given during visit.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 28-AS-20220317135152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARCADIAN, THE	FACILITY NUMBER: 198603445
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/11/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 04/13/2024 Section Cited CCR 87468.1(a)(16)	1 2 3 4 5 6 7	(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will provide in service training to educate staff regarding the providing of medical assistance and evaluation to residents by POC due date
	8 9 10 11 12 13 14	Facility failed to provide Resident#1 with medical evaluation and care plan for fall prevention after sustaining falls which poses an immediate Health, Safety, Personal rights risk to persons in care.	8 9 10 11 12 13 14
Deficiency Dismissed Type B 04/17/2024 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will provide (1) in-service training educating staff regarding the services necessary to meet the needs of residents who were in wheelchair by the POC due date.
	8 9 10 11 12 13 14	Facility failed to provide Resident#1with proper supervision a medical on a timely basis after sustaining a fall which poses a potential Health, Safety, Personal rights risk to persons in care.	8 9 10 11 12 13 14

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: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/17/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220317135152

FACILITY NAME:	ARCADIAN, THE		FACILITY NUMBER:	198603445
ADMINISTRATOR:	STARNES, CINDI		FACILITY TYPE:	740
ADDRESS:	753 W DUARTE ROAD		TELEPHONE:	(626) 445-7981
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	120	CENSUS: 95	DATE:	04/11/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Amber Branconier, Licensee		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was restrained.
Licensee has been suspended by the franchise tax board.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 28-AS-20220317135152

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ARCADIAN, THE	FACILITY NUMBER: 198603445
	VISIT DATE: 04/11/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation consisted of:
Regarding allegation: Resident was restrained. It was alleged that resident was tied into a wheelchair. The investigation revealed of the following. Per resident interviews, seven (7) out of seven (7) residents could not corroborate the allegation and revealed they were not aware of any resident being tied to residents’ wheelchairs. R1 was not interviewed due to R1’s medical condition. Per staff interviews, all staff denied the allegation and revealed staff did not tie residents to their wheelchairs. Review record revealed the facility did not allow restraining residents in any form. Per LPAs’ observation, no residents were being tied to the wheelchairs when conducting the physical plant. Therefore, there’s not sufficient evidence showed resident was restrained at the facility.

Regarding allegation: Licensee has been suspended by the franchise tax board. It was alleged that the franchise tax board suspended the Licensee. The investigation revealed of the following. Per record review, the Franchise Tax Board had received and confirmed the licensee had filed tax to the board for the last two years and current year. Therefore, the franchise tax board did not suspend the licensee.

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

Exit interview conducted with Amber, Licensee. A copy of Licensing Report and Appeal Rights were given during visit.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024

LIC9099 (FAS) - (06/04)

Page: 6 of 6