198600539-7-18-2023-28-AS-RORN-CU4KJ9-20230726075619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/18/2023
Date Signed: 07/18/2023 03:31:52 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
07/10/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230710092615

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: 140	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Andrew DeVera		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff not providing adequate food service.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Andrew DeVera and explained the reason for the visit.
The investigation consisted of: LPA conducted interviews with Med Tech Supervisor at 1:50 PM and Kitchen Supervisor (telephonically) at 2:10 PM. Clients 1-8 (C 1-8) interviewed at 1:05 PM.
LPA collected copies of Staff and Client Rosters.
Tour of the dining room and kitchen were conducted with LPA joined by the Administrator.
In regards to the allegation, Staff not providing adequate food service, based on interviews conducted and information gathered Client's 2-8 all stated that they had never found hair or plastic in their food. C 2-8 also stated they attend meal service for breakfast, lunch and dinner and that staff does a good job and staff will be seen cleaning the dining room after each meal. C2- C 8 stated that there has never been anything unsanitary found in their meals or snacks.
Staff interviewed stated that there have not been any concerns from any other clients in regards to hair or

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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-20230710092615

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: 07/18/2023

NARRATIVE

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any other objects in their food.
Also stated that the kitchen and dining room are cleaned thoroughly after each meal service and also sanitized.
Stated they had told C1 if hair or anything else in their meal to come bring it to the staff and he never has.
Tour of kitchen and dining room were conducted and both were observed to be clean.
Freezers were observed to also be clean with a balanced supply of meats, chicken, vegetables, produce, milk and eggs.

Based on interviews, and 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 conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

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