<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/23/2023
Date Signed: 03/23/2023 04:36:12 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
03/14/2023 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230314133943
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: 170DATE:
03/23/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andrew De Vera, Assistant Administrator TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has insects.
Facility heating/ AC unit is in disrepair.
Facility did not ensure that resident received mail in a timely manner.
Facility is unkempt.
Facility is unsanitary.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegations. On today's visit, LPA met with Assistant Administrator Andrew De Vera, and Medication Supervisor, Julias Elias who assisted with today's visit.

The investigation consisted of the following: Interview(s) with Assistant Administrator, Staff #1, Staff #2, Resident #1- Resident #13, review of pest control invoices, tour of facility, including common areas, and random resident rooms.

Regarding the allegation that the facility has insects: Staff interviewed denied the allegation. Staff stated that the facility has a contract with a pest control company, and the facility is serviced every two weeks. Residents interviewed were unable to corroborate the allegation. 8 out 13 residents stated that the facility doesn't have insects. LPA did not observe insects during facility tour. LPA also reviewed facility pest control invoices during the visit, and observed that a pest control company comes on a regular basis.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
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-20230314133943
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: 03/23/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation that the facility heating/ AC unit is in disrepair: Staff interviewed denied the allegation. Staff stated that the heat and ac are both functioning properly. Residents interviewed were unable to corroborate the allegation. 11 out of 13 residents interviewed stated that the heat and ac are working. LPA observed that the heater was operating during today's visit.

Regarding the allegation that the facility did not ensure that resident received mail in a timely manner: Staff interviewed denied the allegation. Staff stated that the facility mail is delivered to a post office box, and facility staff pick they mail up daily. Staff distribute the mail to residents daily between 1pm and 3pm. 13 out of 13 residents stated that they receive their mail in a timely manner, and it is not a problem.

Regarding the allegation that the facility is unkempt: Staff interviewed denied the allegation. They stated that facility maintenance repairs things as soon as they are aware that repairs are needed. Staff stated that there was a leak recently, and maintenance has already repaired the leak. LPA did not observe any leaks during today's visit. Residents interviewed were unable to corroborate the allegation. 8 out of 13 residents interviewed stated that the facility is not unkempt. They stated that the facility maintenance repair things right away.

Regarding the allegation that the facility is unsanitary: Staff interviewed denied the allegation. They stated that the facility maintenance clean the facility on a daily basis, and they clean areas that need cleaning as soon as they become are aware of it. Residents interviewed were unable to corroborate the allegation. 10 out of 13 residents interviewed stated that the facility is sanitary. They stated that the facility maintenance and housekeeping clean daily, and as soon as they become aware that there is something that needs attention, they take care of it.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted with Andrew DeVera and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2