198600539-8-10-2023-28-AS-RORN-CV7L72-20230830082935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/10/2023
Date Signed: 08/10/2023 12:03:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
08/03/2023 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20230803161904

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:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Julia Elias - Med Tech Supervisor		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff spoke inappropriately to client in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores and Investigator Veronica Padilla from our Investigation Department (IB) conducted an unannounced complaint investigation visit. LPA and IB investigator met with Julia Elias and explain the reason of the visit.

The investigation consisted of the following: LPA requested copies of staff and client rosters. LPA choose random clients to conduct interviews with clients #1- #10 (C1-C10) and interview staff #1-#6 (S1-S6). LPA reviewed and requested copies of "Resident Rights" staff training dated 3/17/23.

The investigation revealed the following: Regarding allegation: Staff spoke inappropriately to client in care. It is alleged a client was drinking a carbonated drink, was talking to S6 about it, and S3 came over and jokingly said that “if it was vodka, it would be good for you.”

(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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-20230803161904

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 08/10/2023

NARRATIVE

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Interviews conducted with clients revealed 9 out of 10 clients stated staff communicate with them respectfully and communicate with others in a respectful manner as well. Interviews conducted with staff revealed 6 out of 6 staff stated to maintain good/respectful communication with clients and that a comment like "if it was vodka, it would be good for you", would be inappropriate at the facility. Interview with S6 revealed that S6 was talking C1 about a drink C1 had purchased. However does not recall S3 being present at the time of the conversation or stating the above comment. Document reviewed revealed staff received training on "Introduction/Orientation and Resident Rights" on 3/17/23.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Andrew De-Vera Assistant Administrator and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

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