198600539-8-15-2023-28-AS-DSIS-CV2RXN-20230825132459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/15/2023
Date Signed: 08/15/2023 03:02:02 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
08/11/2023 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230811133803

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: 145	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Andrew De Vera - Administrator		TIME COMPLETED:	02:29 PM

ALLEGATION(S):

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Staff do not ensure clients receive mail in a timely manner.
Staff is paying client to work at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Andrew De Vera, Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Client & Staff Rosters. LPA interviewed Staff #1 (S1) - Staff #5 (S5), Client #1 (C1) - Client #10 (C10). LPA conducted a tour of the facility, including common areas, Administrative office, kitchen and dining area.

The investigation revealed the following: in regards to the allegation: "Staff do not ensure clients receive mail in a timely manner." It is alleged that facility is not giving mail in time and staff are not going to mailbox to pick up residents mail. Staff interviewed denied the allegation. Staff stated that the mail is delivered to a post office box, and either S1 or S2 pick up the mail and packages from USPS daily. Staff pick up the mail twice (2x) a day everyday at the post office. *****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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-20230811133803

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: 08/15/2023

NARRATIVE

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First trip is in the morning, on their way to work to the facility and second trip is between 11am-12noon to check for late mail distribution and to drop off outgoing mail. Then med tech staff are designated to sort out and distribute the mail to clients daily between 12pm-1pm and 5pm-6pm. 9 out of 10 clients stated that they receive their mail in a timely manner, and it is not a problem. During the observation, LPA did not observe undistributed mail and heard the staff around 12:50pm paging clients to have them pick up their mails in the office. Therefore, there was insufficient evidence to corroborate with the allegation.

Regarding allegation: "Staff is paying client to work at the facility." It is alleged that a resident is working in the kitchen on weekend with no gloves, no hairnet wearing shorts and slip on when working at the kitchen. Staff interviewed denied the allegation. Interviews conducted with staff indicated that they have seen a client worked as a volunteer in the dining area from time to time because she wants to keep herself busy. S1-S5 denied any knowledge of a client being paid to work in the kitchen. 9 out of 10 clients stated that they are not aware of any clients being paid to work in the kitchen. C2 stated that she goes in the dining/kitchen to help and keep herself busy but she is not being paid for the volunteer work. LPA did not observe C2 working in the dining or kitchen during the visit. Therefore, there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with staff, clients, and LPA's observations, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided to Andrew De Vera, Administrator.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC9099 (FAS) - (06/04)

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