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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603445
Report Date: 05/12/2025
Date Signed: 05/12/2025 03:51:14 PM

Substantiated


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
01/17/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250117122939
FACILITY NAME:ARCADIAN, THEFACILITY NUMBER:
198603445
ADMINISTRATOR:HARDIE LINFACILITY TYPE:
740
ADDRESS:753 W DUARTE ROADTELEPHONE:
(626) 445-7981
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:120CENSUS: 105DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Hardie Lin, AdministratorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Due to staff neglect, resident sustained a serious injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the complaint investigation. LPA met with administrator, Hardie Lin, and explained the purpose of the visit.

On 1/23/25, LPA J. Villalobos conducted a health and safety visit and toured the physical plant. LPA did not observe any path obstructions or health and safety hazards in areas toured. Sufficient food supply was observed, and all toxins and sharps were observed to be stored and inaccessible to residents in care. No immediate health and/or safety concerns were noted during the visit. Documents were collected for Resident #1 and a staff was interviewed.
During today’s visit, LPA Chan interviewed the administrator, 5 staff, and 8 residents.

(Continue on LIC9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
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-20250117122939
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: 05/12/2025
NARRATIVE
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Allegation – Due to staff neglect, resident sustained a serious injury. It is alleged that a caregiver closed the bathroom door while Resident #1’s (R1) hand was in the doorway on 2/21/2024. R1 sustained a serious injury to the right middle finger, resulting in part of the finger getting amputated. LPA interviewed the administrator, who acknowledged that the incident occurred at the facility. Administrator Lin stated that Staff #1 accidentally closed the bathroom door while the resident’s hand was placed on the edge of the door. Staff did not see the hand and closed it, causing injury to the finger. The administrator stated that all the care staff were provided a training immediately after the incident to prevent another accident from occurring.

LPA Chan interviewed staff members who indicated that they are careful when handling residents. They ensure that their hands and feet are positioned so that they cannot be injured. Staff stated they try their best to make sure residents are safe. Staff #1 (S1) was interviewed and stated that the incident was accidental and did not see R1’s hand at the door. LPA reviewed R1’s hospital record dated 2/22/2024, and it indicated that R1 was to proceed with surgery to partially amputate the 3rd digit of the right finger.
LPA interviewed 8 residents today. All the residents stated that the staff had not caused injury to them. They think the staff are attentive and well trained.

According to the information gathered, staff did not carefully check to make sure the resident’s hand was not in the doorway. Although the incident was accidental, R1 sustained a serious injury that required surgery and partial amputation of the finger.

Based on interviews conducted and record review, 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 Civil Penalty of $500.00 is being issued today. Refer to LIC 421IM***

An exit interview was held. A copy of this report, LIC421IM, and appeal rights were given to licensee Amber Branconier.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250117122939
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
05/13/2025
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations...
This requirement is not met as evidenced by:
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The licensee shall provide training to all staff to ensure the safety of residents. The in-service log shall be submitted to LPA by 5/13/25.

A civil penalty of $500 is assessed today.
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Based on interviews and record review, staff did not notice R1's hand on the door and closed it, resulting in resident getting partial amputation of the finger, which posed an immediately health, safety, and 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.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
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