198603824-4-27-2026-28-AS-FFIS-DTW26G-20260508170707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603824
Report Date: 04/27/2026
Date Signed: 04/27/2026 05:49:54 PM

Unsubstantiated

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
03/12/2026 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260312113958

FACILITY NAME:	ARCADIA RETIREMENT VILLAGE		FACILITY NUMBER:	198603824
ADMINISTRATOR:	ACHARYA, NIRJARA		FACILITY TYPE:	740
ADDRESS:	607 WEST DUARTE RD		TELEPHONE:	(626) 447-6070
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	200	CENSUS: 81	DATE:	04/27/2026
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Paul Gozon, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility issued an illegal eviction to a resident in care.
Facility accepted and retained residents beyond its' license limitations.

INVESTIGATION FINDINGS:

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

***This licensing report supersedes the licensing report delivered on 03/17/2026. The reason for the superseded report is to add additional information obtained during the investigation. The investigation findings will remain the same. ***

On (04/27/2026), Licensing Program Analyst (LPA) Vaid conducted a subsequent visit to the facility and met with Executive Director Paul Gozon and discussed the purpose of the visit. LPA Vaid and Administrator conducted a facility tour and did not observe any health and safety issues.

On 03/17/2026, Licensing Program Analyst (LPA) Vaid conducted initial investigation to the facility and met with Administrator, during the initial visit, LPA Vaid and Administrator conducted a facility tour. LPA Vaid requested , obtained and reviewed the following documents, staff roster, resident roster, Resident 1-R1-face sheet, physicians report, pre-filled admissions agreement and pre-filled arbitration documents, copy of service plan and resident assessment. LPA Vaid interviewed staff, residents and witnesses.

CONTINUED ON 9099C.......

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

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-20260312113958

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: 04/27/2026

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

***This licensing report supersedes the licensing report delivered on 03/17/2026. The reason for the superseded report is to add additional information obtained during the investigation. The investigation findings will remain the same. ***

Regarding the allegation: Facility issued an illegal eviction to a resident in care. It is alleged that the facility has issued illegal eviction to a resident in care and staff are harassing the resident for non-payment of R1’s monthly room rental. Interviews with four (4) of four (4) staff denied this allegation. According to interviews with staff and records reviewed, R1’s eviction is due to non-payment of monthly rent. According to R1’s records, the room rental has been grand fathered, and the current monthly rental rate will be honored and applied. The facility has agreed to honor the prior admissions agreement made with the prior management company. However, R1 has refused to accept and sign an Admissions Agreement with the current licensee. R1 refers to agreements made with the prior management company regarding payment of monthly rent. Staff interviewed stated they are not harassing residents, including R1 for non-payment of monthly rent. Staff stated they are working with the residents to peacefully resolve non-payment issues. Six (6) of seven (7) residents interviewed could not corroborate this allegation. Residents interviewed stated they are not being evicted, they are paying the monthly rental dues and residents are being harassed by staff for late rental payments. The investigation revealed the R1 is behind on monthly rent payments to the facility and did not reveal that staff are harassing residents in care for non-payment of rent. Based on interviews and records review, 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 the allegation: Facility accepted and retained residents beyond its' license limitations. It is alleged that the facility is retaining residents that do not meet the resident care facility criteria. The facility allowed two (2) young Hispanic adult males (twins brothers) who are not elderly and are not handicapped to reside at the facility. Therefore, the two males should not be allowed to reside in the facility. Additionally, the two Hispanic men are jamming the facilities’ Wi-Fi system and enter R1’s room with an illegal copied key. Interview with four (4) of four (4) staff denied this allegation. According to the staff, there are no residents residing in the facility that match that description of the Hispanic men. Only facility staff that need to enter and clean residents’ room have a master key. Staff stated they are not aware of any residents that fit the description of the two Hispanic twins and are admitted to the facility. Staff were not aware of a Wi Fi jamming device in the facility or aware of non-staff members entering residents’ rooms.
CONTINUED ON 9099C..................

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 28-AS-20260312113958

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: 04/27/2026

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

***This licensing report supersedes the licensing report delivered on 03/17/2026. The reason for the superseded report is to add additional information obtained during the investigation. The investigation findings will remain the same. ***

LPA Vaid observed the resident in room 203 is not Hispanic, and LPA observed room 205 is not occupied by a resident. LPA Vaid observed R1’s TV working and R1 was watching the news R1’s television set. LPA Vaid did not observe R1’s phone, however R1 received a call while R1 was being interviewed by LPA. LPA Vaid did not observe any Wi Fi was being jammed and did not observe a Wi Fi Jaming device in the facility. Six (6) of seven (7) residents interviewed could not corroborate this allegation. Residents are not aware of the licensee’s business operations and residents were unable to verify the identity of the two Hispanic male twins residing at the facility. Residents were not aware of a Wi Fi jamming device and were not aware of a non-staff person entering residents’ rooms. The investigation did not reveal that the facility is operating beyond the limits of the license. Based on interviews conducted, records review, and observations made, 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 Staff (Paul Gozon, Executive Director) and a copy of the licensing complaint report was provided to staff, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3