198603824-9-1-2026-28-AS-WSHO-DYWVLF-20261016163152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603824
Report Date: 09/01/2026
Date Signed: 09/01/2026 04:42:22 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
08/14/2026 and conducted by Evaluator Blanca Gonzalez

COMPLAINT CONTROL NUMBER: 28-AS-20260814151003

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: 98	DATE:	09/01/2026
		UNANNOUNCED	TIME BEGAN:	01:47 PM
MET WITH:	Administrator Paul Gozon		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff do not meet residents’ toileting needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA was greeted by staff and the reason for the visit was explained. Administrator Paul Gozon arrived shortly after.

On 08/18/16, LPA Gonzalez requested and obtained staff roster and resident roster. LPA reviewed facility admission agreement and interviewed staff #1-7 (S1-S7) and residents #1-8 (R1- R8). During today’s visit, LPA collected and reviewed copies of the front desk call logs for July 2026 and August 2026 and interviewed S8.

continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260814151003

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: 09/01/2026

NARRATIVE

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The investigation revealed the following: Regarding the allegation “Staff do not meet residents’ toileting needs,” it was reported that over the last several months, since returning from the hospital, staff have not been assisting R1 with toileting. There have been several instances (approximately six) in which R1 had to contact the fire department to assist off the toilet because staff did not assist. LPA interviewed 8 staff. 8 out of 8 staff deny the allegation. S4 stated caregiver response time is usually 5-10 minutes. S5 stated staff response time is quick, if they are on the same floor. S7 stated as long as they are not helping another resident, they will respond right away because they don’t like to keep the residents waiting. S2, S3 and S5 all stated R1 needs more than one caregiver for assistance with being lifted off the commode. S3 stated sometimes a caregiver will arrive but has to wait for other caregivers to arrive to assist. S2 and S6 stated R1 has called the fire department for a lift assist because R1 grew impatient waiting for additional caregivers to assist the responding caregiver. LPA interviewed 8 residents. 6 out of 8 residents interviewed deny the allegation. R2 stated caregivers respond within minutes. R4 stated when they call the front desk, staff comes quick. R5 stated they will call the front desk from their phone and doesn’t wait too long for a response. R6 stated they have no complaints, staff respond in a timely manner. LPA reviewed front desk call logs from July and August, after R1 returned from the hospital. LPA counted 33 calls made to the front desk from R1 for a caregiver/lift assist with an average response time of 5 minutes.

Based on interviews, and record review, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to Administrator Paul Gozon.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Blanca Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026

LIC9099 (FAS) - (06/04)

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