198600539-3-28-2023-28-AS-RORN-CT2NLP-20230622103353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/28/2023
Date Signed: 03/28/2023 12:36:08 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
03/22/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230322091342

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: 164	DATE:	03/28/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yitzi Teichman		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are not taking universal precautions while administering medications.

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 allegation. 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 9:10 AM, and Staff 1 (S1) at 10:50 AM and Clients 1-8 (C 1-8) from 9:35 A.M. to 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 and reviewed C 1's medication.
In regards to the allegation Staff are not taking universal precautions while administering medications, based on interviews conducted and information gathered LPA reviewed medication for C 1 and there were no medications reviewed that smelled rotten. C1 was administered all medication upon review.
Staff interviewed stated that staff wash hands and use hand sanitizer and gloves are worn. Medication is popped out of the bubble pack into a cup and is never touched by hand. Also stated that C 1 has complained previously about medication and food being contaminated due to his behaviors, but they have looked at

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: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

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-20230322091342

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: 03/28/2023

NARRATIVE

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medication and food after C1 has complained and the food and medication were good.
Interview with Client C 1 who stated he does not know whether staff wash their hands or not.
Stated that pill is contaminated, but next dose it is not contaminated after and it is normal.
Stated that food is contaminated also.
Said he did take all his medications and didn't refuse and could not provide proof that medication was contaminated.
Interview with 7 of 8 clients who stated they have never missed any medication dose.
7 of 8 clients have never smelled any odor or anything rotten with their medication.
6 of 8 clients interviewed stated that staff have masks and gloves and 1 of the 8 was unsure.

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.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023

LIC9099 (FAS) - (06/04)

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