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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 08/31/2023
Date Signed: 08/31/2023 05:33:45 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
08/23/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230823110510
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: 147DATE:
08/31/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Assistant Administrator Andrew De VeraTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff not assuring food served is wholesome for consumption.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos and Sanjay Vaid conducted an unnanounced complaint investigation for the allegation listed above. LPA's met with assistant administrator Andrew De Vera and the purpose of the visit was discuseed.

Initial visit conducted on 8/25/23 consisted of the following: LPA Villalobos interviewed Staff #1-#2 (S1-S2) and Client #1 (C1). LPA collected and reviewed the food menu for the last 2 weeks as well as the nutritionist notes. LPA collected and reviewed copies of the staff and client rosters.

Todays visit consisted of the following: LPA's interviewed staff #3-#5 (S3-S5) and Clients #2-#15 (C2-C15). LPA's toured the physical plant and oberved the food supply. LPA's collected a copy of the current staff and client roster. The investigation revealed the following:

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: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
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-20230823110510
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: 08/31/2023
NARRATIVE
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In regards to the allegation "Staff not assuring food served is wholesome for consumption." it was alleged that on 8/23/23 the clients were served nasty coffee and gray contaminated eggs for breakfast. (5) of (5) Staff interviewed denied the allegation. (14) of (15) Clients interviewed could not corroborate the allegations. LPA was provided an image of the alleged eggs but they did not look contaminated. The eggs appeared to have char marks from cooking. Clients interviewed denied that the staff have served rotten or bad smelling coffee and also denied having received contaminated eggs in their meals. LPA's observed the food supply and did not observe any expired produce or eggs. There is no documentation on file of there being spoiled coffee or contaminated eggs in the facility. Based on the interviews conducted, file review, 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: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2