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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/17/2023
Date Signed: 10/17/2023 02:19:07 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
10/11/2023 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231011142819
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: 136DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andrew DeVera TIME COMPLETED:
02:35 PM
ALLEGATION(S):
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9
Staff inappropriately touched resident
Resident's air conditioner is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wong conducted an initial 10 days complaint visit to ascertain information pertaining to the above mentioned allegation(s) and to establish the validity of the complain. LPA met with Marketing Christina Vasquez and allowed the entry of the facility and assisted with the visit.

The investigation consisted of the following: On today's date, LPA interviewed fourteen (14) clients (C1-C14) and assistant administrator and six staff (6) and obtained clients rosters and staff roster.


(See LIC 9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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-20231011142819
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: 10/17/2023
NARRATIVE
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The investigation revealed of the following: Allegation#1 "Staff inappropriately touched resident" LPA interviewed fourteen (14) clients and all denied the allegation. They never seen any staff inappropriately touched clients in the facility. Also there's no staff ever made any comments that made them uncomfortable. LPA interviewed staff and they all denied the allegation and reported they are not tolerating that in the facility. The two alleged staff was reported for inappropriately touched clients but after the interviews conducted with staff and clients and one of the alleged person who is not a staff member in the facility.

Allegation#2 "Resident's air conditioner is in disrepair" LPA interviewed fourteen (14) clients and eight out of fourteen clients denied the allegation and said the air-conditioning in their rooms are working well and no problem with their air conditioner even on a hot day. LPA interviewed staff and stated that there's no client complained the air-conditioning in their rooms are not working well recently or they felt hot in their rooms. During the facility tour, LPA observed four rooms were pretty warm but the assistant administrator reported the clients never reported to the staff or maintenance staff about their air conditioner is in disrepair and staff did not know at all, therefore staff never fixed their air conditioning issues for those rooms. LPA also observed the thermometer around those rooms and the temperature is within the Title 22 regulation.

Based on the interviews conducted with staff and clients and tour of the facility, 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 allegations are UNSUBSTANTIATED.

Exit interview was conducted with Andrew De Vera and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2