198600539-12-1-2022-28-AS-RORN-CMCQJB-20221222111227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 12/01/2022
Date Signed: 12/01/2022 03:25:01 PM

Unsubstantiated

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
11/28/2022 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221128135341

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 168	DATE:	12/01/2022
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Yitzi Teichman- Adminstrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility plumbing in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannounced complaint visit for the purpose of investigation the above-mentioned allegation above. LPA Maldonado met with Administrator Yitzi Teichman and ecplained the purpose for the visit.

During today's visit, LPA Maldonado obtained a copy of the client/staff roster, copy of the receipt for plumbing reparations, conducted a tour of the physical plant with S3, and interviewed Staff# 1-3 (S1-S3), Clients# 1-10 (C1-C10), and the plumber who made the repairs.

The investigation revealed the following:
Regarding allegation- Facility plumbing in disrepair.
It is alleged that on 11/28/22, Client# 1 (C1) was unable to shower due to the water coming out of their shower, bathroom faucet, and toilet was brown and had an odor. Upon arrival to the facility, LPA observed a work van parked outside the facility with workers getting in. (Report Continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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-20221128135341

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: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 12/01/2022

NARRATIVE

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During interviews with S1-S3, it was stated that the work van that was there were the plumbers who were called to the facility to repair a leak that occurred in the front of the building on 11/30/22. (3) of (3) staff interviewed stated that maintenance was able to stop the leak, but plumbers were called to conduct a thorough inspection and arrived on 12/01/22 at 8:00am to make reparations. LPA phoned the plumber that made the repair and the plumber explained that the repair for the leak that occurred during today's visit was not related to the issue regarding the complaint. The plumber stated that the repair was regarding a hole in the main line in the front of the building and one pipe was replaced. The plumber also explained that it would be rare for only 1 client restroom to experience said issue, since all pipe lines are connected; However, it could be possible. All staff interviewed stated they had no knowledge of any clients' restroom plumbing not working. All staff interviewed stated no complaints were received from clients regarding their restrooms. Each client bedroom has it's own restroom. During interviews conducted with C1-C10, (9) of (10) clients stated they did not experience a different color/malodorous water coming out of their restroom plumbing and have not had issues. LPA toured room 201 and observed the water in the restroom toilet, shower, and wash basin to be operating properly- there was no color or odor to it.

Based on the interviews conducted and files reviewed, there was not enough supportive evidence to concur with the reported allegation. 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.

An exit interview was conducted with administrator Yitzi Teichman and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC9099 (FAS) - (06/04)

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