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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/10/2023
Date Signed: 07/10/2023 11:19:35 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
07/03/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230703090616
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:
07/10/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Staff Julia Elias TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Staff are not preventing resident from harassing other resident while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation above. LPA met with Staff Julia Elias and the purpose of the visit was discussed.

The investigation consisted of: LPA Villalobos interviewed Staff #1-#5 (S1-S5) and clients #2-#12 (C2-C12). C1 was not available for interview. LPA collected copies of Staff and Client Rosters. LPA reviewed C1 and C2's file and collected copies of facility documents relevant to the investigation. LPA additionally conducted a tour of the physical plant. The investigation revealed the following:

In regards to allegation "Staff are not preventing resident from harassing other resident while in care" it was alleged that C2 has been harrassing C1 in the facility and staff have not addressed the issue....

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: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
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 2
Control Number 28-AS-20230703090616
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: 07/10/2023
NARRATIVE
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(5) of (5) Staff interviewed denied the allegation. (11) of (11) Clients interviewed could not corroborate the allegation. C2 denied ever spitting or harassing C1. Staff interviews do not show that staff is aware of any incident of C2 spitting or harassing C1 in care. Interviews suggest that the incident, if occurred, may have happened out in the community. Interviews with clients shows that staff will address issues when they become aware of them. LPA did not observe any documents on file regarding C2 harassing or spitting on any client in care. 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.

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: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2