198600539-6-8-2023-28-AS-RORN-CT2QV8-20230622122955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/08/2023
Date Signed: 06/08/2023 09:20:19 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/08/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230508112740

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: 165	DATE:	06/08/2023
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Andrew De Vera - Assistant Administrator		TIME COMPLETED:	09:35 AM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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*This report supersedes the report dated 05/15/23 to make corrections to the LIC 9099-D*
Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegation. LPA met with Andrew De Vera (Assistant Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora obtained copies of the client and staff rosters, and interviewed Assistant Administrator, Staff 1 (S1), Client 1 - Client 10 (C1 - C10), and representatives from both laundry machine companies. LPA obtained copies of work orders for washers and dryers repairs for the last 3 months. LPA conducted a tour of all 4 laundry rooms.

The investigation revealed the following: regarding the allegation "facility is in disrepair”, it is alleged that one dryer and two washing machines are working properly which are insufficient to accommodate approximately 100 clients. (Continued to LIC 9099-C)

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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 3

Control Number 28-AS-20230508112740

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 06/08/2023

NARRATIVE

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Interview with Assistant Administrator revealed that he has been made aware of the issues with the washers and dryers, and has placed work orders on 05/02/2023 and 05/12/2023 with both of the facility's contracted laundry machine companies. There are two laundry machine companies because the facility leased washers and dryers from two different companies. These companies come to fix the machines and if not fixable then replace them with refurbished machines. Assistant Administrator has followed up with them and they have not been able to send out a technician. LPA called the laundry machine companies and company A stated that they have 2 work orders pending for this facility (05/02/2023 & 05/12/2023) and company B stated they have 2 work order pending (05/02/2023), but both have not been able to send out a technician because they have a high amount of pending work orders. Company A could not provide the LPA with a date of when they can come because they are back up with other work orders. Company B stated that they will come on 05/17/2023 to replace 1 dryer for work order 05/02/2023 and they stated a new work order was received today (05/15/2023) at 10:14am and they will come service this new work order on 05/18/2023 to repair 2 dryers. Residents interviewed revealed that 9 out of 10 residents corroborated with the allegation.
During the tour, the LPA observed that the facility has 4 laundry rooms with a total of 6 washers and 6 dryers. The LPA confirmed the following: Side A bottom floor: LPA observed 1 dryer working, 1 dyer not working (does not heat), and both washers working. Side A top floor: LPA observed 1 washer working, 1 washer not working (does not turn on), and both dryers not working (1 does not turn on and the other does not spin). Side B bottom floor: LPA observed the washer is not working (issues with agitation) and dryer is not drying clothes properly because it needs a 2nd cycle at high temperature to completely dry the clothes. Side B top floor: LPA observed washer is working properly and the dyer heats up, but it does not spin. Although the facility has created work orders for the laundry machine companies to come repair the machines, these companies have not been able to come and the facility has just been waiting. The facility currently has 4 working washers and 1 working dryer for 165 clients to use.

Based on LPA's interviews, records reviewed and observations, the preponderance of evidence standard has been met, therefore the allegations are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 1 are being cited on the attached LIC 9099-D.

Exit interview held and a copy of the report and appeal rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230508112740

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/15/2023 Section Cited CCR 85088(d)	1 2 3 4 5 6 7	Fixtures, Furniture, Equipment and Supplies (d) If the facility operates its own laundry, necessary supplies shall be available and equipment shall be maintained in good repair. This requirement is not met as evidenced by	1 2 3 4 5 6 7	Facility is to ensure that Title 22 Section 85088 regulations are met at all times. Additionally, facility will submit a plan to comply with Title 22 Section 85088 to CCLD by 06/15/2023.
	8 9 10 11 12 13 14	Based on interviews, records review and observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The facility currently has 2 washers and 5 dryers that are not working.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC9099 (FAS) - (06/04)

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