198600539-3-16-2023-28-AS-TVAO-CR8VBK-20230425161738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/16/2023
Date Signed: 03/16/2023 12:29:49 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
03/10/2023 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20230310135648

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: 168	DATE:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Andrew De-Vera -Assistant Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility served client contaminated food
Staff did not treat client with dignity and respect
Facility speaker volume high causing ear discomfort for client
Staff failed to provide a safe environment for clients

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) LPA Mary Flores conducted an unannounced complaint investigation visit at the facility regarding the above allegation(s). LPA met with Andrew De Vera assistant Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested a roster of the staff/client roster. LPA conducted a tour of the kitchen and reviewed food supplies. LPA interviewed client #1(C1),#2(C2),#3(C3),#4(C4),#5(C5),#6(C6),#7(C7),#8(C8),#9(C9), and staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5). LPA reviewed staff training for S2.

The investigation revealed the following: Regarding allegation: Facility served client contaminated food. It is alleged there was pink vomit on the outside and inside of client's cup, and black pepper and a brown substance contamination in milk. Interviews with clients revealed 8 out of 9 clients interview stated food has not been contaminated or found anything inside or outside their food. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20230310135648

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: 03/16/2023

NARRATIVE

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1 out of 9 clients stated there were items in the outside of the cup which were questionable. Interviews with staff revealed 5 out of 5 staff interviews stated food is served cleaned and practice hygiene practices before serving. Kitchen staff stated that when dishes have been noticed to have something on them they are removed and not served. During tour of the facility's kitchen LPA observed the food preparation areas are clean, refrigerator stored food cover and dated, and pantry had food and boxes dated. No debris or substances were observed in the food areas.
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.

Regarding allegations: Staff did not treat client with dignity and respect and Staff failed to provide a safe environment for clients. It is alleged staff lied to client which insulted client's dignity and client doesn’t feel safe at the facility as client is being targeted by the staff at the facility. Interviews with clients revealed 5 out of 9 clients interview stated staff can be disrespectful, yell, or are rude to clients. 4 out of 9 clients stated staff are good and respectful to the clients. Interviews with staff revealed 3 out of 5 staff stated relationships with clients are respectful and 2 out of 5 staff stated clients can become aggressive and staff must de-escalated situations by bringing it up to a different staff to assist. LPA Flores reviewed staff training on resident rights provided on 7/5/22 for S#2.
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.

Regarding allegation: Facility speaker volume is high causing ear discomfort for client. It is alleged the volume on speakers was loud which hurt client's ears and staff need to speak soft and normal on the microphone. Interviews with clients revealed 2 out of 9 clients interview stated the volume of the speakers is loud when announcing. 1 out of 7 clients stated the volume can be loud sometimes. 6 out of 9 clients stated the volume of the speakers is not loud. Interviews with staff revealed 3 out of 5 staff stated the volume does not work properly and clients state they cannot hear and it is adjusted to 2 no higher than that. 1 out of 5 staff stated that the volume of the speaker is fine and it is not loud. 1 out of 5 staff stated voices of staff differ and some staff may sound louder than others and staff are aware that they must regulate their voice when using the microphone.

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 was conducted with Andrew DeVera and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

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