198600539-7-25-2023-28-AS-RORN-CUKRB9-20230810125221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 07/25/2023
Date Signed: 07/25/2023 03:52:51 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
07/20/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230720084144

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: 150	DATE:	07/25/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Assistant Administrator Andrew De Vera		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff did not report incident to proper agencies.

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 Assistant Administrator Andrew De Vera and the purpose of the visit was discussed.

On todays visit LPA conducted the following: Toured the physical plant, Interviewed Clients #3-#10 (C3-C10) , Staff #1-#5 (S1-S5) , Clients #1 (C1) and #2 (C2) refused interview, reviewed and collected documents from C1 and C2's file as well as documentation from S2's File, and reviewed and obtained copies of the facility staff and client roster. The investigation revealed the following:

In regards to the allegation "Staff did not report incident to proper agencies." it was alleged that there was a trespasser in the facility that got into a fight with S2's spouse on the premises and the incident was not reported to the authorities. (5) of (5) 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: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

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-20230720084144

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: 07/25/2023

NARRATIVE

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(8) of (8) Clients interviewed could not corroborate the allegation. Interviews with staff show that there may have been an altercation between two individuals of the public outside on the sidewalks near the facility on 7/18/23. The altercation did not involve any clients or staff and was unrelated to the facility; therefore, there was no report to the sheriffs department made. S2 denied the incident even occurred and that their spouse would be involved in any fights around the facility. LPA was not provided with further details as to how or why the alleged altercation would have happened. Client interviews do not show any knowledge of the incident occurring or of anyone attempting to trespass the facility on 7/18/23. LPA review of facility file did not show reports of alleged trespasser being reported or of any fights outside the facility. Based on files reviewed, observations, and interviews conducted with clients and staff, there was not enough supportive evidence to corroborate the 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, a copy of this report and Appeals Rights were provided to the Assistant Administrator, Andrew De Vera.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2023

LIC9099 (FAS) - (06/04)

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