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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/24/2023
Date Signed: 01/24/2023 04:55:40 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
08/17/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220817121029
FACILITY NAME:PICO RIVERA GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:MEIR SHAUL YITZI TEICHMANFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:185CENSUS: 168DATE:
01/24/2023
UNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Administrator Yitzi Teichman TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Adults residing at the facility are distributing illegal drugs on the premises.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint visit for the allegation above. LPA met with Administrator Yitzi Teichman and explained the purpose of the visit.

The investigation consisted of the following:
Initial visit was conducted on 8/18/22 where LPA conducted a health & safety check and toured the entire facility. LPA obtained copy of the staff roster, client roster, and documents pertaining to Client #1 and Client #2: Identification and Emergency Information, Admission agreement, Appraisal/Needs and Services Plan, Physician's Report, House rules. The Department of Social Services Investigation Bureau (IB) Investigator D. Seng was assigned to investigate the above allegation. Investigator interviewed Clients #1-#7 (C1-C7) and staff #1-5 (S1-S5).

The investigation revealed the following; In regards to the allegation, "Adults residing at the facility are distributing illegal drugs on the premises" it was alleged that C1 and C2 abused or sold drugs in the facility.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
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 2
Control Number 28-AS-20220817121029
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: 01/24/2023
NARRATIVE
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(5) of (5) Staff interviewed denied the allegation. (7) of (7) Clients interviewed could not corroborate the allegation. Interviews conducted by Investigator Seng show that C1 and C2 deny abusing or selling drugs in the facility. Interviews do not show that staff or clients have knowledge regarding C1 and C2 using drugs or selling drugs in the facility. The departments concludes based on interviews, file review, and observations; 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.

An exit interview was conducted with the Administrator Yitzi Teichman and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2