198600539-1-12-2023-28-AS-MVAO-CN6TV5-20230117140321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/12/2023
Date Signed: 01/12/2023 03:58:05 PM

Unsubstantiated

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
02/09/2021 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210209111722

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	DOMINGUEZ, SANTOS		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 169	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Assistant Administrator Andrew De Vera		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff retaliated against a resident while in care
Staff are not taking universal precautions while providing assistance
Residents are being served cold food while in care
Residents are misusing the common areas while in care
Staff are not properly maintaining the facility
Staff are not properly trained
Residents are not provided with comfortable accommodations while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted a subsequent complaint visit to deliver investigation findings for the above stated allegations. LPA met with Assistant Administrator Andrew De Vera and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 2/16/21, LPA conducted a telephone interview with Administrator Santos Dominguez. LPA requested and received copies of Staff and Client Rosters. On 1/12/23, LPA conducted interviews with Assistant Administrator Andrew De Vera, Staff 1-5 (S1-5) and Clients 1-16 (C1-16). LPA collected copies of Staff/ Client Rosters and facility menu. LPA additionally conducted a tour of facility which included observations of common areas, kitchen, 6 client rooms (#7, #8, #47, #50, #106 and #114) and medication room. LPA reviewed 4 Staff files.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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 5

Control Number 28-AS-20210209111722

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: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 01/12/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff retaliated against a resident while in care, it is alleged that facility staff retaliate against clients in care when they suspect that a client has filed a complaint. Interviews conducted with facility staff revealed that facility staff do not retaliate against clients in care. Staff stated that they are aware that it is a client's right to file a complaint if they feel that they have to and if they have any concerns regarding the facility and/ or facility staff. Staff indicated that they are aware of their responsibility as a mandated reporter regarding making reports if they witness or are aware of any verbal and/ or physical abuse happening in the facility. Interviews conducted with 15 out of 16 facility clients stated that facility staff do not retaliate against clients if they believe that a client is calling in complaints. They also stated that facility staff are respectful and are very helpful. 10 out of 16 clients stated that they are aware that they can call in any concerns to Community Care Licensing Division (CCLD) and stated that they can also let their case worker know if they have any concerns regarding the facility and/ or facility staff. During the time of the visit, LPA did not observe staff speaking inappropriately to clients. Based on statements gathered from interviews conducted with staff and clients there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff are not taking universal precautions while providing assistance, it is alleged that facility staff do not wear masks or gloves when serving food and when distributing medication. Interviews conducted with facility staff revealed that facility staff wear masks and gloves when cleaning client rooms, serving food and when distributing medications to facility clients. Kitchen staff stated that they wear gloves at all times when handling food as well as when they are serving food to the clients. Facility staff also stated that they wash their hands as needed as well as sanitize their hands. Interviews conducted with 13 out of 16 facility clients stated that facility staff wear masks and gloves when serving food and distributing medications to clients. 1 client stated that they have not seen staff wear masks or gloves when serving food or when distributing medications. 1 client stated that they do not pay attention and do not care too much if staff are wearing masks or gloves when serving food or distributing medications. During the time of the visit, LPA observed kitchen staff wearing masks and gloves when serving and handling food. LPA also observed staff wearing masks and gloves when distributing medications to facility clients. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210209111722

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: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 01/12/2023

NARRATIVE

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For allegation, Residents are being served cold food while in care, it is alleged that the food is served cold. Interviews conducted with facility staff revealed that food is not served cold to the clients. They stated that the only time the food is cold is if the item or particular dish is supposed to be served cold for example salad, fruit, and sandwiches to name a few food items. Kitchen staff stated that the food is only served cold if it is supposed to be served cold. Kitchen staff stated that food is kept in the oven so that it can remain warm until it is ready to be served to the clients. Interviews conducted with 12 out of 16 facility clients stated that they are satisfied with the food service and stated that food is served warm and is only served cold when it has to be served cold. 3 clients stated that the food is not served cold and that they are just not satisfied with the food service and prefer to eat outside of the facility. During the time of the visit, LPA observed kitchen staff serving lunch and LPA observed staff removing food from the ovens before serving the food to the clients. LPA also inspected the facility refrigerator and freezer and observed the temperature readings. The temperature reading for the refrigerator was 40 degrees F and 0 degrees F for the freezer. All readings met Title 22 regulations. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Residents are misusing the common areas while in care, it is alleged that certain clients urinate and vomit in the common areas. Interviews conducted with facility staff revealed that clients do not urinate or vomit in the common areas. Staff stated that staff conduct rounds hourly and have not observed any clients urinating or vomiting in the common areas. Staff stated that the common areas are cleaned as needed throughout the day and there are trash can set out in the common areas for clients to use. Interviews conducted with 13 out of 16 facility clients revealed that the common areas are cleaned every day and staff also check common areas throughout the day. 13 out of 16 clients stated that clients do not urinate or vomit in the common areas. 1 client stated that they saw 1 client urinate but stated that the incident happened more than 2 years ago. 1 client did not answer the questions regarding the allegation. LPA conducted a tour of all facility common areas and observed that they were clean, did not smell any odors that would indicate that clients urinate or vomit in the common areas. LPA observed staff conducting rounds and also observed trash cans located in all facility common areas. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20210209111722

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: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 01/12/2023

NARRATIVE

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For allegation, Staff are not properly maintaining the facility, it is alleged that clients are not provided clean towels on a regular basis and toilets are not properly cleaned everyday. Interviews conducted with facility staff revealed that client rooms are cleaned on a daily basis and that clients are also provided with clean towels on a daily basis. Staff stated that if a client needs additional clean towels they can request them and they will be provided. Staff stated that the toilets are cleaned on a weekly basis but stated that if any toilets need urgent cleaning before the particular room is due for their weekly deep cleaning it will be cleaned. Staff stated that the rooms are deep cleaned weekly which includes change of linens, laundry and cleaning the toilet and shower. Staff stated that rooms are regularly cleaned everyday which consists of making the bed, tidying up the room, cleaning out the trash cans, replenishing hygiene products and hand/ bath towels. Interviews conducted with 15 out of 16 facility clients revealed that their rooms are cleaned every day. They stated that their toilets are cleaned once a week, they are provided towels everyday and their trash is taken out everyday. LPA conducted a tour of 6 client rooms and observed the rooms to be clean, have clean bath towels, and the toilets were observed to be clean. LPA observed staff cleaning rooms during the time of the tour. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff are not properly trained, it is alleged that new staff members have not been trained. Interviews conducted with facility staff revealed that they are properly trained. LPA reviewed 4 staff files and observed in-service training on topics such as CPR/ First Aid, Medication Administration, Activities of Daily Living, Licensing requirements, and mandated reporter to list a few. 15 out of 16 clients that were interviewed stated that they are overall satisfied with their stay at the facility and believe that the staff are properly trained. Based on statements gathered from interviews conducted with staff and clients, as well as LPA review of staff files there was not enough supportive evidence to concur with the reported allegation.

For allegation, Residents are not provided with comfortable accommodations while in care, it is alleged that staff constantly make announcements and do so in a loud manner. It is also alleged that staff laugh loudly while they are working. Interviews conducted with facility staff revealed that staff do make announcements as needed to inform clients if they have a call, have to take their medicine, have to collect mail, or have a visitor. Staff stated the announcements are made appropriately and they do not believe that they are done in a loud manner. Staff stated that they do laugh at times with other staff or with clients during

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20210209111722

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: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 01/12/2023

NARRATIVE

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conversations but do not laugh in a loud manner. Interviews conducted with 14 out of 16 facility clients revealed that they are satisfied with the services that they receive and stated that they are comfortable. They stated that staff are not loud when making announcements and that the volume does not bother them. They also stated that they are satisfied with their relationships with staff and that staff are very helpful with anything they might need. 1 client stated that they do believe that the announcements are too loud. 15 out of 16 residents stated that staff are respectful at all times and they do not have any concerns. LPA conducted a tour of all facility which included common areas, kitchen and client room and while conducting the tour did not observe that the speaker system is too loud. LPA also observed staff and did not observe staff being loud or speaking in loud voices. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Assistant Administrator Andrew De Vera.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC9099 (FAS) - (06/04)

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