198600539-1-27-2023-28-AS-RORN-CUBVB3-20230802161651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/27/2023
Date Signed: 01/27/2023 03:01:54 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
07/29/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220729115517

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: 165	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	02:01 PM
MET WITH:	Assistant Administrator Andrew De Vera		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Resident takes illegal drugs on the premises

Staff did not provide a safe and comfortable environment for resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos and Kevin Gaines conducted a subsequent complaint visit for the allegation above. LPA met with Assistant Administrator Andrew De Vera and explained the purpose of the visit.

The investigation consisted of the following:
Initial visit was conducted on 8/1/22 where LPA Valeria Maldonado conducted an unannounced Health and Safety Check visit and toured the physical plant. LPA did not observe any path obstructions or health and safety hazards. Sufficient food supply was observed and all toxins and sharps were observed to be stored and locked away properly, unaccessible to client's in care. LPA requested and obtained a copy of the staff and client roster. No immediate health and/or safety concerns were noted. The Department of Social Services Investigation Bureau (IB) Investigator L. Patterson was later assigned to investigate (1) of the (2) above allegations. Investigator interviewed Clients #1-#6 (C1-C6) and staff #1-3 (S1-S3).

On Todays visit, LPA Villalobos interviewed Staff #4-#6 (S4-S6) and clients #7-16 (C7-C16).
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: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20220729115517

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: 01/27/2023

NARRATIVE

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The investigation revealed the following; In regards to the allegation, "Resident takes illegal drugs on the premises" it was alleged that C1 abused drugs in the facility. (6) of (6) Staff interviewed denied the allegation. (15) of (16) Clients interviewed could not corroborate the allegation. Investigator reports do not show that C1 was observed to have any drugs on hand or in their room. Interviews conducted by LPA and Investigator do not show that C1 was observed using drugs in the facility. File review did not show that C1 was involved in incidents regarding drug use in the facility. The departments conclude 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.

In regards to the allegation "Staff did not provide a safe and comfortable environment for resident in care" it was alleged that C1 would attack clients and staff in the facility. (6) of (6) Staff interviewed denied the allegation. (15) of (16) Clients interviewed could not corroborate the allegation. Interviews do not show that C1 got into physical altercations with other clients or staff in the facility. Interviews show that C1 and their roommate did not get along and staff assisted C2 in finding another room. Review of files did not show incident reports regarding C1 getting into fights with other clients. 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.

Exit Interview conducted 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: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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