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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/03/2023
Date Signed: 07/03/2023 03:00:25 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
05/27/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220527163655
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: 140DATE:
07/03/2023
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Assistant Administrator Andrew De VeraTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff refused to give resident medication
Staff does not prevent resident(s) from having a firearm
Staff made inappropriate comments towards resident
Staff did not safeguard resident personal belongings
Resident has bed bugs
Resident's bed is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced subsequent complaint visit for the allegations above. LPA met with Assistant Administrator Andrew De Vera and explained the purpose for the visit.

Initial visit conducted on 6/2/22 consisted of the following: LPA interviewed Staff #1-#5 (S1-S5) and Clients #1-#12 (C1-C12). LPA toured the physical plant. LPA collected and reviewed documents from C1's file.

On todays visit , LPA interviewed Client #13-15 (C13-C15). LPA interviewed Staff #6-#7 (S6-S7). The investigation revealed the following:

In regards to the allegation "Staff refused to give resident medication" it was alleged that S3 refused to provide C1 their medication on 5/26/22. (7) of (7) Staff interviewed denied the allegation...

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: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
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-20220527163655
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: 07/03/2023
NARRATIVE
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 (14) of (15) Clients interviewed could not corroborate the allegation. Staff interviewed denied that C1 was ever denied their medication for any reason. Interviews stated that C1 would argue with staff because they did not like taking their medication on a schedule but staff have to follow physicians orders. LPA reviewed facility and C1 notes but did not observe notes of medication refusal or of C1 missing medication for the alleged date. Interviews with clients does not show staff refusing to provide them their medications. Based on interviews, observations, and file review conducted 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

In regards to the allegation "Staff does not prevent resident(s) from having a firearm" it was alleged that there is a client in possession of a fire arm. (7) of (7) Staff interviewed denied the allegation. (14) of (15) Clients interviewed could not corroborate the allegation. Interviews with staff do not show there is suspicion of any client possessing a firearm and if there was a room check would be conducted and authorities contacted if needed. Clients interviewed did not show knowledge of clients being in possession of fire arms in the facility. LPA was not provided with details as to who would have a firearm in the facility. LPA did not observe any residents with firearms in the facility at the time of the initial visit and on this date. Based on interviews and observations conducted 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

In regards to the allegation "Staff made inappropriate comments towards resident" it was alleged that staff in the facility make inappropriate comments towards C1. (7) of (7) Staff interviewed denied the allegation. (14) of (15) Clients interviewed could not corroborate the allegation. Interviews with staff and clients do not state that the staff make inappropriate comments towards clients in care. LPA was not provided proof that staff have made inappropriate comments towards clients in care. LPA did not observe staff making inappropriate comments to any clients in care. Based on interviews and observations conducted 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

Continued on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220527163655
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: 07/03/2023
NARRATIVE
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In regards to the allegation "Staff did not safeguard resident personal belongings" it was alleged that staff confiscated C1's smoke pipe and refused to return it. (7) of (7) Staff interviewed denied the allegation. (14) of (15) Clients interviews could not corroborate the allegation. Interviews show that during a room check into C1's room, staff observed marijuana in a smoke pipe and confiscated it. Interviews stated that it is against the facility rules to smoke in the room and it appeared as though it was still lit. Staff had a conversation with C1 about the use of marijuana and the effects it may have to clients who take other medications and was offered C1 their smoke pipe back cleaned. C1 did not want it back. C1 confirmed the information provided to LPA at the time of the initial visit. Based on interviews and observations conducted 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.

In regards to the allegation "Resident has bed bugs" it was alleged that C1 had bed bugs in their room. (7) of (7) Staff interviewed denied the allegation. (14) of (15) Clients interviewed could not corroborate the allegation. Interviews with staff stated that C1 does not allow staff to go into their room to clean it often. Staff have observed C1 throwing trash all over the floor that could possibly attract bugs but they have not seen any bed bugs in the room. LPA entered C1's room during the initial visit and observed C1's room. LPA did not observe bed bugs on either of the two beds in the room. C1 stated they have not seen any lately either and do not have any bites or signs of them at the moment. File review does not show C1's room being treated for bed bugs. Based on interviews, observations, and file review conducted 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

In regards to the allegation "Resident's bed is in disrepair" it was alleged that C1's bed had broken springs and staff refuse to replace it. (7) of (7) Staff interviewed denied the allegation. (14) of (15) Clients interviewed denied the allegation. Staff interviewed were not aware of C1 having a broken bed as C1 has not told them anything about that. Staff stated that there is an new bed in C1's room along with the one C1 uses that could be used if that were the case. LPA observed C1's room at the time of the initial visit and noticed C1 using one bed for themselves and the other bed to place their belongings on. Interview with C1 stated that the springs are not broken on their bed but it is getting a dip so maybe they would use the other bed to sleep on. LPA did not observe C1's bed to be broken or having springs popping out of it. Based on interviews and observations conducted 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 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: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3