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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603445
Report Date: 04/26/2024
Date Signed: 04/26/2024 04:44:47 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
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220317135152
FACILITY NAME:ARCADIAN, THEFACILITY NUMBER:
198603445
ADMINISTRATOR:STARNES, CINDIFACILITY TYPE:
740
ADDRESS:753 W DUARTE ROADTELEPHONE:
(626) 445-7981
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:120CENSUS: 97DATE:
04/26/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Martha Garcia, managerTIME COMPLETED:
10:31 AM
ALLEGATION(S):
1
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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
***This report serves as an amendment and supersedes the original complaint investigation report created on 04/11/24. The purpose of this report is to re-issue citations. The finding remains as Substantiated. ***

Today, Licensing Program Analyst (LPA) Bonnie Tao conducted a subsequent complaint visit to re-issue citations regarding the allegations listed above. LPA Tao met with Martha, manager and discussed the purpose of the visit.

On 03/18/22, LPA Tao conducted the initial visit. During the 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 conducted a physical plant with Office manager and did not observe any signs of neglect, abuse or other immediate health and safety threats.

(-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: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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 8
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: 04/26/2024
NARRATIVE
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***This report serves as an amendment and supersedes the original complaint investigation report created on 04/11/24. The purpose of this report is to re-issue citations. The finding remains as Substantiated. ***

On 04/11/24 visit, LPAs Tao and Reyes continued the investigation, interviewed Administrator, staff, and residents, conducted a physical plant with staff#9 (S9), and delivered the complaint investigation findings.

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 the 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 the 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 to 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 the 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 a 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 chronic bilateral subdural hematoma.

(-continued in LIC 9099C-)
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 8
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: 04/26/2024
NARRATIVE
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7
8
9
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***This report serves as an amendment and supersedes the original complaint investigation report created on 04/11/24. The purpose of this report is to re-issue citations. The finding remains as Substantiated. ***

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’s 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.

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 to 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 the 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 chronic bilateral subdural hematoma.

(-continued in LIC 9099C-)
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 8
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: 04/26/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
19
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21
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23
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25
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27
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29
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32
***This report serves as an amendment and supersedes the original complaint investigation report created on 04/11/24. The purpose of this report is to re-issue citations. The finding remains as Substantiated. ***

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: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 8
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
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220317135152

FACILITY NAME:ARCADIAN, THEFACILITY NUMBER:
198603445
ADMINISTRATOR:STARNES, CINDIFACILITY TYPE:
740
ADDRESS:753 W DUARTE ROADTELEPHONE:
(626) 445-7981
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:120CENSUS: 97DATE:
04/26/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Martha Garcia, managerTIME COMPLETED:
10:31 AM
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
***This report serves as an amendment and supersedes the original complaint investigation report created on 04/11/24. The finding remains as unsubstantiated. ***

Today, Licensing Program Analysts (LPA) Bonnie Tao conducted a subsequent complaint visit to re-deliver the finding regarding the allegations listed above. LPA Tao and Reyes met with Martha Garcia, manager and discussed the purpose of the visit.

On 03/18/22, LPA Tao conducted the initial visit. During the 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 conducted a physical plant with Office manager and did not observe any signs of neglect, abuse or other immediate health and safety threats.

(-continued in LIC 9099C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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 8
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: 04/26/2024
NARRATIVE
1
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3
4
5
6
7
8
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11
12
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15
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31
32
***This report serves as an amendment and supersedes the original complaint investigation report created on 04/11/24. The finding remains as unsubstantiated. ***

On 04/11/24 visit, LPA Tao and Reyes continued the investigation, interviewed Administrator, staff, and residents, conducted a physical plant with staff#9 (S9), and delivered the complaint investigation findings. The investigation consisted of the following.

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.

An exit interview was conducted with Amber, Licensee. A copy of Licensing Report was given during the visit.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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: 04/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/29/2024
Section Cited
CCR
87463(a)(1)
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7
(a)…reappraisals shall document changes in the resident's physical, medical,…condition… (1) A physical trauma...
This requirement is not met as evidence by:
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7
Licensee will review Title 22 Regulations, Section 87463 and submit a written plan to ensure staff would re- appraise residents upon re-admission, develop care plan detailing resident’s fall risk and document the changes of the residents’ physical and medical condition by the POC due date.
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Facility failed to provide Resident#1 (R1) with re-appraisal, failed to develop a care plan based on the resident’s specific needs and failed to address the resident’s fall risk after R1 sustained falls which poses an immediate Health, Safety, Personal rights risk to persons in care.
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Type B
05/01/2024
Section Cited
CCR
87468.2(a)(4)
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(a)(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
This requirement is not met as evidence by:
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Licensee will review Title 22 Regulations, Section 87468.2 and provide a written statement explaining how facility will deliver care to residents by staff that are sufficient in numbers, qualifications, and competency to meet residents’ needs.
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Facility staff failed to provide Resident#1 (R1) adequate care and supervision based on R1’s specific needs and failed to address R1’s fall risk after sustained falls which poses a Potential Health, Safety, Personal rights risk to persons in care.
8
9
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Besides, Licensee will provide in-service training educating staff regarding the care/supervision that necessary to meet residents’ needs by the POC due date.
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: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 8
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: 04/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2024
Section Cited
CCR
87405(d)(1)
1
2
3
4
5
6
7
(d) The administrator shall have the qualifications…(1) Knowledge of the requirements for providing care and supervision appropriate to the residents.
This requirement is not met as evidence by:
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3
4
5
6
7
Licensee will review Title 22 Regulations, Section 87405. Licensee will provide a statement to ensure administrator would have the knowledge providing care and supervision appropriate to the residents by the POC due date.
8
9
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12
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14
Administrator failed to provide Resident#1 (R1) adequate care and supervision based on R1’s specific needs which poses a Potential Health, Safety, Personal rights risk to persons in care.
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10
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14
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7
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5
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7
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7
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: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 8 of 8