<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:17:49 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
02/08/2023 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230208122650
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: 145DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Andrew De VeraTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility appliances are in disrepair
Staff mishandle the residents medication
Staff do not meet the dietary needs of the residents
Staff do not safeguard the residents confidential information
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Andrew De Vera and explained the reason for the visit.

The investigation consisted of: On 2/15/23, LPA conducted interviews with Administrator Yitzi Teichman, Assistant Administrator Andrew De Vera, Staff 1-4 (S1-4) and Clients 1-10 (C1-10). LPA collected copies of Staff and Client Rosters. LPA reviewed C1s 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, medication room, outside patio and facility lobby. On 6/20/23, LPA conducted interviews with C11-16 and collected copies of staff and client rosters. LPA also collected copies of facilty menu and other documents relevant to the investigation.

(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)
Page: 1 of 4
Control Number 28-AS-20230208122650
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
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
Investigation revealed the following: Regarding allegation, Facility appliances are in disrepair, it is alleged that facility staff are aware that washing machines and dryers have not been working for months and they have not fixed the appliances. Interviews with facility staff indicated that the washers and dryers appear to work properly at this time. They stated that when washers and dryers are reported to be in disrepair, they place a service order right away with the contracted laundry machine company. The most recent work order for the laundry machine was serviced on 1/6/23. Maintenance staff also stated that the laundry machines are sometimes unplugged by the clients and that clients also overfill the appliances at times. Maintenance staff stated that when that happens they have to restart the washer/ and or and instruct the clients to restart the wash cycle or dry cycle. Maintenance staff also stated that the washers take a little bit longer to start up, however, they are not in disrepair. Per staff, when any of the appliances are not working they will put up a note indicating when the machines are out of order and also directing the clients to the location of appliances that are working. LPA interviewed a total of 16 clients, and 4 out of the 16 stated that some washers and/or dryers are not working at this time. 11 clients stated that when the washers or dryers break down, they will report it to the staff and the machines will be fixed in a timely manner and stated that they do not have concerns about the washers or dryers at the moment as there are always working machines and there has not been a time when all washers and/ or dryers were not working. LPA toured all the laundry areas in the two facility buildings and the machines appeared to be working at the time of the visit. Some of the machines were being used and there were no notes indicating any of them were out of order. 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.

For allegation, Staff mishandle the residents medications, it is alleged that client medications and medication refills are not ordered in a timely manner. Interviews conducted with facility staff revealed that all client's medications and medication refills are ordered timely. Staff stated that when there are changes in medication made by client's doctors, staff will properly dispose of discontinued medications and will immediately order and begin dispensing the newly ordered prescriptions. Staff also stated that all refills are made timely and that all clients have 30 days of medication at the facility. Staff stated that medication refills are placed approximately one week in advance to allow for processing and delivery of the refills. 13 out of 16 facility clients stated that they do not have any concerns regarding their medications. They stated that they get their medications timely and on a daily basis and have not experienced not having any of their medications due to staff not properly handling or reordering their medication refills. During the time of the
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)
Page: 2 of 4
Control Number 28-AS-20230208122650
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
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
visit, LPA toured facility medication room and did not observe anything that is of concern. Based on LPA observations, LPA review of documents and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff do not meet the dietary needs of the residents, it is alleged that facility menu is not prepared by a registered dietician and lacks substantive nutritional value. Menu lacks recommended allowance of grains, fruits and vegetables. It is also alleged that food that is served does not taste good and that the menu does not change. Staff do not give clients seconds and clients are hungry and will go through the trash to find food and clients also share leftover food. Staff staff stated that the food that is served to clients meets all clients dietary needs and stated that all servings include grains, protein, fruits and vegetables. Administrator stated that the menu is prepared by a registered dietician to ensure that the meals that are served are meeting the dietary needs of all clients in care. Staff interviewed denied that the menu does not change and stated that there are four menus that are rotated throughout the month on a weekly basis, client's are always welcomed to seconds and denied that clients have to dig in the trash for food. Interviews conducted with 13 out of 16 facility clients stated that they are satisfied with the food service and stated that food is well balanced and meets their dietary needs. 3 clients stated that they prefer to eat out of the facility and that is a personal choice. During the time of the visit, LPA observed kitchen staff serving lunch and observed that the meal being served appeared to be well balanced with a selection of rice, vegetables, protein and fruit. LPA also observed that there was an adequate supply of food which consisted of 2-day perishables and 7-day non-perishables. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff do not safeguard the residents confidential information, it is alleged that personnel staff from other programs are privy to prescription information of clients and facility staff have provided client's medical information to such persons who are not privileged to such information per HIPPA. It is also alleged that clients fear and have been known to be subject to retaliation by facility staff. Interviews conducted with facility staff revealed that all clients personal and confidential information is always kept confidential. Staff stated that medical personnel are provided with client's medical information when needed but client's personal and confidential information is never openly provided to anyone that is not medical personnel. Staff stated that if ever they need to speak to any client about their confidential/ medical information it is always
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)
Page: 3 of 4
Control Number 28-AS-20230208122650
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
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
done in a private setting. Staff denied that client's are subject to retaliation by facility staff. 14 out of 16 facility clients stated that they do not have any concerns regarding their confidential information and stated that if staff ever need to talk to them about anything that is confidential it is always done in private. 14 out of 16 clients stated that they do not feel fearful at facility and stated that they feel safe, They also stated that they have not felt that staff retaliate against them if they speak up about something that concerns them. Based on statements gathered from interviews conducted with staff and clients there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are 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)
Page: 4 of 4