198600539-6-15-2023-28-AS-RORN-CVLNXE-20230912105100

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/15/2023
Date Signed: 06/15/2023 11:22:13 AM

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
06/09/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230609132156

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: 147	DATE:	06/15/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Andrew De Vera, administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff did not intercede when a resident was threatening another resident in care.

INVESTIGATION FINDINGS:

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

Investigation consisted of the following:
LPA conducted interviews of staff from Staff #1 (S1) through Staff #4 (S4); interviews of clients from client#1 (C1) through client#11 (C11); and conducted a facility tour. LPA obtained copies of staff/client rosters and C1's facility files.

Investigation revealed of the following:
In regard to the allegation, "staff did not intercede when a resident was threatening another resident in care," it was alleged that a client was threatening to harm Client #1(C1) and staff did not intervene. Four (4) out of four (4) staff interviewed were denied the allegation which no client had threatened C1 and no such incident was reported by C1 or staff. If such incident happened, staff would intervene immediately, re-direct clients' attention, de-escalate the situation, and investigate the incident afterward. (- see LIC9099-C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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-20230609132156

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: 06/15/2023

NARRATIVE

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Ten (10) out of eleven (11) clients interviewed could not corroborate the allegation which they did not see client had threatened another client while in care.

Per C1's interview, C1 stated an unknown client was threatened C1 and staff#1 had intervened into situation. C1 stated nobody was harmed and staff#1 had helped to re-direct that unknown client during the incident. LPA toured the facility during today’s visit and did not observe any clients had threatened other clients.

Based on LPA's interviews and observations, the investigation revealed staff would intervene when a client was threatening by another client; although, the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

LPA conducted an exit interview with Andrew De Vera, administrator and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC9099 (FAS) - (06/04)

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