198600539-6-20-2023-28-AS-RORN-CY8R9S-20231205114958

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:14:52 PM

Unsubstantiated

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
06/14/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230614100636

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: 145	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Andrew De Vera		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not preventing resident from threatening another resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Andrew De Vera and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Andrew De Vera, Staff 1-3 (S1-3) and Clients 1-16 (C1-16). LPA collected copies of Staff and Client Rosters. LPA reviewed C16's file and collected copies of facility documents relevant to the investigation. LPA additionally conducted a tour of the facility which included observations of a random selection of client rooms in both buildings A and B, laundry rooms in both buildings A and B, outside patio, medication room, activity rooms and facility lobby.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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-20230614100636

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: 06/20/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff are not preventing resident from threatening another resident, it is alleged that a facility client has been threatening another facility client for approximately 6 months. It is also alleged that this client paces the halls at night and yells out racial slurs, and bangs loudly on the walls and floors throughout the night. Staff allegedly say that they cannot do anything about it and give client an attitude when client reports their concerns. Interviews conducted with facility staff revealed that staff do prevent behaviors that are threatening towards facility clients. They stated that staff redirect and de-escalate threatening and disruptive situations. Staff also stated that there is a client that has been disruptive and that staff do follow up and intervene when this client is causing trouble or being loud. Staff denied ever telling any client that they cannot do anything about a client's behavior or giving any facility client an attitude. Administrator stated that they are currently in the process of seeking a solution regarding C16's behavior and have issued an eviction notice. 14 out of 16 clients stated that they feel safe at the facility and that staff follow up on their concerns. They stated that staff do interfere when there are any client's causing trouble or being disruptive. 3 clients stated that there is a client that yells and bangs on the walls but that staff immediately intervene and take care of the situation. They stated that C16 walks around the facility at times talking to himself and not directly at anyone in particular. They also stated that they have not heard C16 threaten anyone and that they mainly talk to themselves. During time of the visit, LPA did not observe any facility client being disruptive or threatening. Based on statements gathered from interviews conducted with staff and clients and LPA observations there was not enough supportive evidence to concur with the reported allegation.

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 held. A copy of the report was provided to Administrator Andrew De Vera.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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