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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/15/2023
Date Signed: 03/15/2023 02:23:07 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
03/08/2023 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230308122121
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: 164DATE:
03/15/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Yitzi TeichmanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility did not adhere to medication schedule.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Yitzi Teichman and explained the reason for the visit.
The investigation consisted of: LPA conducted interviews with Administrator Yitzi Teichman at 10:10 AM, Staff 1 (S1) and Staff 2 (S2) telephonically at 11:30 AM and Clients 2-8 (C 2-8) at 10:35 AM. LPA collected copies of Staff and Client Rosters. LPA reviewed C1's file and collected copies of facility documents relevant to the investigation.
In regards to the allegation Facility did not adhere to medication schedule, based on interviews conducted and information gathered review of medication administered for Client's 2-7 was conducted at today's visit.
All medications were on schedule for the month of March 2023 and were observed by LPA to have been administered when checking medication and Medication Administration Log.(MAR)
6 of 7 client's interviewed stated that medication was always administered at 7 A.M., 3 P.M. and 7 P.M. and it was given quickly with little wait times.



Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
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 4
Control Number 28-AS-20230308122121
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: 03/15/2023
NARRATIVE
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Staff interviewed stated that medication schedule is always adhered to with medication administered 3x a day.
Client's are called on the microphone to come to the med-room and client's will wait in line and are administered medication promptly.
Staff stated that C1 requests medication on short notice and becomes impatient if having to wait.
Staff said they follow procedure and have to check Medication Administration Log (MAR) to ensure medication has not been taken already and will have to check with Administrator because C1 wants more than 1 day of medication when leaving.
Staff stated that there have been times when C1 has gotten medication to leave, but then stays at facility so they follow all the proper rules to make sure C1 does not stockpile the medication.

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.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
03/08/2023 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230308122121

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: 164DATE:
03/15/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Yitzi TeichmanTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff made an inappropriate comment towards resident.
INVESTIGATION FINDINGS:
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In regards to the allegation Staff made an inappropriate comment towards resident, based on interviews conducted and information gathered there were 2 of the 7 client's who stated that staff had made inappropriate comments to client's.
One client stated that Staff S2 said Why are you crying? and go ahead keep crying.
Another client stated that 4 months ago when asking staff for a key to the room the staff stated I don't have to cater to your ass.
Interview with Staff S2 who stated that she did say to C1 in person now you're being all tough and you are getting crazy now.
Also confirmed that she said to Client C 8 alright already and did say quit crying.

Based on interviews, observation, and documents review conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Tittle 22, Division 6 and Chapter 1 are being cited.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20230308122121
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2023
Section Cited
CCR
80072(a)(1)
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Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:

(1) To be accorded dignity in his/her personal relationships with staff and other persons.

The requirement is not met as evidenced by:
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The administrator will ensure each client shall have personal rights which accord dignity in his/her personal relationship with staff and other persons. The administrator will retrain the staff about personal rights and will send the staff training log to LPA by POC due date.
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LPA's interviews with clients and staff that reported staff made inappropriate comments at clients which posed a potential risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4