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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/28/2023
Date Signed: 03/28/2023 04:44:18 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
01/24/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230124160657
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: 165DATE:
03/28/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Yitzi Teichman TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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 Facility staff are not providing a safe environment for clients in care.


INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation above. LPA met with Administrator Yitzi Teichman and the purpose of the visit was discussed.

Initial visit on 1/27/23 consisted of the following: LPA toured the physical plant, interviewed Staff#1-#6 (S1-S6) and clients #1-10 (C1-C10). LPA collected the following documents: staff and client roster, copies of documents from Staff #6 (S6) and Staff #7's (S7) file, copies of documents from C1's file.

On Todays visit LPA interviewed clients #11-16 (C11-C16) and Staff #8. S7 no longer works in the facility and was not available for interview. The investigation revealed the following:

In regards to the allegation "Facility staff are not providing a safe environment for clients in care." it was alleged that S6 has a relative who threatens clients in the facility and staff don't do anything about it.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
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)
Page: 1 of 2
Control Number 28-AS-20230124160657
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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(6) of (6) Staff interviewed denied the allegation. (14) of (16) Clients interviewed could not corroborate the allegation. (2) of (16) clients interviewed stated that S6's relative threatens clients when they are outside of the facility. LPA was not provided with proof that S6's relative has threatened clients or that this person has entered the facility and threatened clients in care. LPA was not provided dates of incidents occurring. S6 denied the allegation and stated that their relative has never entered the facility or communicated with clients in care. Interviews with staff do not show knowledge of S6's relative ever entering the facility or threatening clients in care. Based on the interviews conducted and observations; 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 and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
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)
Page: 2 of 2