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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/21/2023
Date Signed: 03/21/2023 03:10:43 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
03/14/2023 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230314103932
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: 167DATE:
03/21/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Yitzi Teichman - Administrator TIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff do not allow resident to use a walking cane
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegation. LPA met with Yitzi Teichman (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora obtained copies of the client and staff rosters, interviewed Administrator, Staff 1 - Staff 2 (S1 - S2), Client 1 - Client 6 (C1 - C6) and Director of College Hospital of Cerritos Partial Hospitalization Program. LPA obtained copies of C1's identification and emergency information, physician report, appraisal/needs and services plan, and admission agreement.

The investigation revealed the following: regarding the allegation "staff do not allow resident to use a walking cane”, it is alleged that C1 bought a walking cane, but the administrator took it away. C1 allegedly has a medical condition that gets her dizzy and an unstable gait when walking which led to buying a cane.
(Continued to LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
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-20230314103932
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: 03/21/2023
NARRATIVE
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Administrator and staff interviewed denied the allegation and stated that C1 has not been seen with a walking cane. They also stated that C1 has not informed them of walking issues; and that C1 does not have balance issues, is able to walk properly without a walking cane and no walking cane has been prescribed. C1 is currently being held at a hospital, but LPA interviewed C1 over the phone. LPA asked C1 if C1 bought a walking cane and C1 answered "no, I need one". Interview with C2 revealed that C2 is C1's roommate and C2 has not seen C1 with a walking cane. Interviews with C3 - C6 revealed that they are neighbors of or know C1 and have not seen C1 with a walking cane. Review of C1's appraisal/needs and services plan dated 11/11/2021, does not indicate that C1 has walking issues or needs assistance to ambulate. Review of C1's physician report dated 12/07/2021, shows that C1 is ambulatory, able to leave the facility unassisted and able to ambulate without assistance.

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 held and a copy of the report was provided
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2