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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 04/10/2023
Date Signed: 04/10/2023 05:27:12 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
04/04/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230404123108
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: 166DATE:
04/10/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Assistant Administrator Andrew De Vera TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff does not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA's) Jose Villalobos, Tena Herrera and Erik Zaragoza conducted an initial complaint investigation visit for the allegation abvoe. LPA's met with Assistant Administrator Andrew De Vera and the purpose of the visit was discussed.

On Today's visit, LPAs toured the physical plant, observed the food supply, interviewed clients #1-#16 (C1-C16) and Staff #1-#6 (S1-S6). LPA collected copies of the staff and client roster as well as documents from C1's File. The investigation revealed the following:

In regards to the allegation "Facility staff does not treat resident with dignity and respect.", it was alleged that mulitple facility staff speak to C1 inappropriatley making C1 feel mistreated. (6) of (6) Staff interviewed denied the allegation. (15) of (16) clients interviewed could not corroborate the allegation. Interviews do not show that staff interject in C1's conversations or speak in angry or rude tone towards C1...

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: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
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-20230404123108
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: 04/10/2023
NARRATIVE
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LPA's were not provided with date and time of incidents. (15) Clients interviewed were not able to corroborate that any staff have spoken inappropriately to any clients of the facility. 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 De Vera 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: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2