198600539-5-8-2023-28-AS-FFIS-CZ4SB5-20240102124323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 05/08/2023
Date Signed: 05/08/2023 03:05:07 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
05/01/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230501091454

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: 160	DATE:	05/08/2023
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Assistant Administrator Andrew De Vera		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff threatens resident in care.
Staff is stealing resident's medications.
Staff do not treat residents with dignity or respect.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) above. LPA met with Assistant Administrator Andrew De Vera and the purpose of the visit was discussed.

On todays visit , LPA interviewed Staff #1-5 (S1-S5) and clients #1-16 (C1-C16). LPA toured the physical plant , collected copies of staff and client roster , reviewed and collected copies of documents from C1-C2's file. The investigation revealed the following:

In regards to allegation "Staff threatens resident in care" it was alleged that staff threatened to evict C1 unjustly. (5) of (5) Staff interviewed denied the allegation. (15) of (16) Clients interviewed could not corroborate the allegation. Interviews with staff and C1 stated that C1 moved out of the facility on their own on 5/2/23 and took their belongings and medications. Interviews state C1 went to social security office to become their own payee and returned to the facility to collect the check for May 2023 once it was done....

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: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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-20230501091454

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: 05/08/2023

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

Staff interviewed denied threatening C1 with an eviction or ever forcing C1 to leave. Interview with C1 stated staff did not want C1 in the facility any longer so they threatened to evict C1 but never gave an eviction notice or anything in writing. C1 stated to have found a place to go on their own and so they moved out. LPA was not provided with proof that C1 was threatened with eviction by staff. File review did not have any documentation of C1 being evicted. Based on interviews, file review, 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.

In regards to the allegation "Staff is stealing resident's medications." it was alleged that staff where taking C1's Xanax medication. (5) of (5) Staff interview denied the allegation. (15) of (16) Clients interviewed could not corroborate the allegation. Interviews do not show that staff took medications from C1. C1 was unable to provide proof that staff took their medication. File review of C1's medication administration record (MAR) shows that C1 took their medication while in the facility and did not miss taking their xanax as prescribed. Interviews show that C1 moved out on 5/2/23 and took their medication with them. There were no medications in the facility for LPA to observe. Based on interviews, file review, 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.

In regards to the allegation "Staff do not treat residents with dignity or respect" it was alleged that staff are not treating C1 with dignity and respect because of their religion. (5) of (5) Staff interviewed denied the allegation. (15) of (16) Clients interviewed could not corroborate the allegation. Interviews do not show that clients are treated differently based on their religion. Interviews do not show clients being discriminated for their religion. LPA was not provided with example as to how C1 was not treated with dignity and respect because of their religion. Based on interviews, file review, 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: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2