198600539-2-7-2023-28-AS-RORN-CPKM8X-20230303082350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/07/2023
Date Signed: 02/07/2023 01:31:41 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
02/06/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230206093407

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:	02/07/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Andrew DeVera		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff refused to seek medical care for resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint investigation at the facility for the allegation above. Upon arrival, LPA met with Yitzi Teichman (Administrator) and explained the purpose of the visit.

The investigation consisted of the following: LPA interviewed administrator, four staff (S1-S4) and sixteen clients (C2-C17) and obtained documents including staff and client roster, C1's incident report dated on 10/21/22 and 04/21/21, face sheet, physician report and appraisal/needs and service plan

The investigation revealed of the following: In regard to the allegation of "Staff refused to seek medical care for resident in care." LPA interviewed sixteen clients and all denied the allegation and reported staff never refused to seek medical care for clients in care. Staff always on top of it and take good care of their medical needs.
(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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-20230206093407

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: 02/07/2023

NARRATIVE

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LPA interviewed staff and all denied the allegation and reported they never refused seeking medical care for clients. Staff stated that not even on one occasion that they would refuse clients' medical needs or care. Administrator stated that C1 had not been to hospital for a while and C1 never reported that required medical care lately.

Based on the interviews conducted with clients and staff and record review, the investigation revealed; 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

Exit interview conducted with Assistant Administrator Andrew DeVera and a copy of this report and appeal right was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC9099 (FAS) - (06/04)

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