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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/11/2023
Date Signed: 07/11/2023 02:39:28 PM

Substantiated


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
06/23/2023 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230623135009
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:
07/11/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Andrew De Vera, Assistant AdministratorTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff do not prevent a resident from harassment a resident.
Staff do not prevent marijuana smoking inside facility.
Facility is littered with cigarette butts.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to investigate the above allegations. The purpose of the visit was explained to Administrative Assistant Christina Vasquez. Administrator Andrew De Vera arrived shortly after.

The investigation consisted of the following: On 6/27/2023, a physical plant inspection of the exterior and interior common areas/hallways and kitchen was conducted. The focus was on maintenance, trash on the floor, smell of the facility, and food preparation and observation of breakfast meal time. Staff (S1-S3) and residents (R1-R2) were interviewed. LIC 500 Personnel Report, resident roster, house rules, and maintenance job description documents were obtained. During today's visit, staff (S4- S6) and residents (R3- R11) were interviewed. Lunch time meal preparation was observed. A physical plant inspection of common areas and exterior physical plant was conducted.

***report narrative continues next page****
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
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 5
Control Number 28-AS-20230623135009
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: 07/11/2023
NARRATIVE
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Allegation: Staff do not prevent a resident from harassment from another resident. It is alleged that there have been several incidents and most recently in mid June, that a resident pulled down their pants, was not wearing underwear, and scratched their bottom in the dining room while residents ate their meal. Three (3) out of six (6) staff stated there are a couple of residents that do not have belts and their pants accidentally fall down. According to staff interviews, 2 to 3 residents have complained to staff about one (1) identified resident often having their pants down and showing their bottom while walking around because the resident has grasping issues and mental disability. Seven (7) out of 11 residents interviewed stated they have felt harassed or witnessed harassment. One (1) resident reported that their chest was grabbed by another resident. Resident interviews revealed that there are at least three (3) residents that walk around with their pants down exposing themselves to others. Residents feel staff are not addressing the issue. Although staff stated they have addressed the issues with several residents and purchased clothing items for the alleged residents, it has not stopped from occurring.There is sufficient evidence to corroborate the allegation.

Allegation: Staff do not prevent marijuana smoking inside facility. It is alleged that residents smoke marijuana inside their rooms and in the facility premises. The marijuana smell is mostly after dinner time and at night. Based on interviews conducted and physical plant tour dated 6/27/2023, the findings indicate there are residents smoking marijuana inside the facility. On 6/27/2023, LPA toured the facility with a facility staff, the smell of marijuana was noticeable in the hallways. Six (6) out of 11 residents interviewed stated that there are some residents that smoke marijuana inside their rooms and in the patio areas. A total of six (6) staff were interviewed, all acknowledged there are residents who smoke marijuana inside. Staff stated that random room checks are performed at least 2 times a week during the day shift. Staff reported that per House Rules, smoking marijuana in the property is not permitted, but some residents sometimes smoke it in the outdoor patio areas and in their room. The facility does not have medical marijuana physician orders in place. There is sufficient evidence to corroborate the allegation.


*See next page.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20230623135009
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: 07/11/2023
NARRATIVE
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Allegation: Facility is littered with cigarette butts. It is alleged that there is discarded cigarette butts inside the facility in the elevator, upstairs lounge area, in the front of the building, and all around the facility common areas. A total of six (6) staff were interviewed, of which all acknowledged sometimes residents throw cigarette butts on the floor inside facility grounds, and smoke in front of the building entrance that is a non-smoking area. Per Assistant Administrator, janitorial staff are supposed to sweep the butts during each shift but during the physical plant inspection. On 6/27/2023, LPA and Administration staff observed that maintenance staff are not sweeping or picking up the butts in the non-designated smoking area i.e. front entrance area and in in common areas such as, dining room and hallways. Pictures were taken. During today's visit, cigarette butts were observed on the floor in the patio areas. There is sufficient evidence to corroborate the allegation.

Based on observation and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC 9099D.

An exit interview was conducted with Assistant Administrator Andrew De Vera. A copy of the report and appeal rights were issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20230623135009
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2023
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met evidenced by:
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Administrator agreed to provide a plan on how staff will address incidents and ensure the safety or residents. Submit plan and proof of staff training.
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Based on interviews conducted, staff and residents confirmed incidents in which a couple residents have exposed their private areas to other residents and/or have sexually harassed residents; which poses a potential health and safety risks to persons in care.
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Type B
07/18/2023
Section Cited
CCR
80064(a)(3)
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Administrator - Qualifications and Duties. The administrator shall have the following qualifications: Knowledge of and ability to comply with applicable law and regulation. This requirement was not met evidenced by:
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Administrator shall review House Rules and Plan of Operation facility policies focusing on the prohibition of smoking inside facility premises.
1. Administrator shall assess the residents and obtain medical marijuana cards for residents in need and obtain marijuana prescription. 2. Submit proof
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Based on observation and interviews conducted, it was confirmed that some residents smoke marijuana inside their rooms and facility grounds; which poses a potential health and safety risk to persons in care.
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NOTE: Smoking policies are set in place, but Administration staff shall follow through in maintaining protocol.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20230623135009
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/18/2023
Section Cited
CCR
80087(a)
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Buildings and Grounds. The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement was not met evidenced by:
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Assistant Administrator agreed to address the issue with maintenance staff and hire additional staff if needed to upkeep facility grounds. Assistant Administrator shall ensure the hallways, common areas, and outdoor patios are swepted and cleaned regularly.
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Based on observation, on 6/27/2023 LPA observed cigarette butts in dining room floor, hallways, outdoor patio areas, and the front entrance was littered with cigarette butts. Pictures were taken. Today, cigarette butts were also observed in the exterior grounds; poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5