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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/24/2023
Date Signed: 08/24/2023 04:31:00 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
05/05/2023 and conducted by Evaluator Christine Wong
COMPLAINT CONTROL NUMBER: 28-AS-20230505113549
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: 150DATE:
08/24/2023
UNANNOUNCEDTIME BEGAN:
04:03 PM
MET WITH:Andrew DeVeraTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Lack of staff supervision resulting in residents overdosing on illegal substances while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong met with Andrew DeVera. The purpose of today's visit is to deliver findings for the above allegation.

On 05/08/23, LPA Irra conducted the initial visit and met with Andrew De Vera (Facility Administrator). During this visit, LPA conducted a tour of the facility. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA reviewed Client #1 (C-1) through Client #3 (C-3) files and obtained relevant documentation. LPA also obtained copies of the client and staff rosters.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
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 2
Control Number 28-AS-20230505113549
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: 08/24/2023
NARRATIVE
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Allegation: Personal Rights: Lack of staff supervision resulting in residents overdosing on illegal substances while in care.

The investigation consisted of the following: The investigation was assigned to Investigation’s Branch (IB) Investigator, Olivia Spindola. IB Investigator conducted interviews with alleged victims (C-1 through C-3), staff, clients and C-3’s family member. IB Investigator also reviewed records for C-1 through C-3. The investigation revealed the following: On 04/04/2023, C-1 was hospitalized at Beverly Hospital (BH) after C-1’s roommate reported to the facility management that C-1 appeared to be in medical distress. On 05/02/2023, C-2 was transported to BH after C-2 was slumped over a patio chair at the facility. On 05/03/2023, C-3 was hospitalized at BH after C-3 was found unconscious on a sidewalk near the facility. The IB investigation revealed that C-1 through C-3’s narcotics overdoses were unrelated to one another. The following information was gathered by Investigator Spindola: C-3 indicated C-3 bought narcotics outside this facility and at times from an unidentified individual in the facility. C-2 indicated C-2 believe C-2 took a Xanax pill a friend gave C-2 to help C-2 sleep, however, the Xanax caused C-2 to be hospitalized. C-1 indicated C-1 bought Methamphetamine from an individual at a nearby store. Investigator Spindola was unable to determine if the facility staff was aware of C-1 through C-3 of bringing narcotics inside the facility, purchasing narcotics from staff or that staff abused narcotics. Per Investigator Spindola, “since the residents are free to go into the community it is laterally impossible for the facility staff to know when residents have purchased and carried narcotics into the facility or abuse narcotics in their rooms, therefore the case was closed as Unsubstantiated”.

Although the allegation(s) 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 and a copy of this report and appeal rights were provided to Winnie Greco.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2