198600539-10-17-2023-28-AS-RORN-CWWM8U-20231024092343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/17/2023
Date Signed: 10/17/2023 03:01:35 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
10/09/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231009092247

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: 136	DATE:	10/17/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Assistant Administrator Andrew De Vera		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff does not ensure medication is being correctly dispensed as prescribed to client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation above. LPA met with assistance administrator Andrew De Vera and the purpose of the visit was discussed.

The following was conducted during todays visit: LPA interviewed Client #1-#12 (C1-C12) and Staff #1-#7 (S1-S7), collected documents from C1's file as well as their medication record for the month of October, copies of the staff and client rosters, and LPA toured the physcial plant. The investigation revealed the following:

In regards to the allegation "Staff does not ensure medication is being correctly dispensed as prescribed to client in care" it was alleged that C1 was provided medications soaked in water and was also provided another clients medications by staff...

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: 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)

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Control Number 28-AS-20231009092247

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: 10/17/2023

NARRATIVE

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(7) of (7) Staff interviewed denied the allegation. (11) of (12) Clients interviewed could not corroborate the allegation. Interviews show that staff provide clients water cups separate from their cups with medications. Staff interviewed denied there ever being water mixed in with any clients medications. Interviews state that there was a day where C1 has refused medications from the staff because there was spilled water on the counter top where clients pick up their medications, but there was no water spilled in anyone's medication cups. Medication cups are kept in the office and are passed out to each individual one by one and do not get filled with water. Interviews did not show there was a medication error for C1. LPA reviewed documentation for C1 and did not observe documentation regarding medication error, but there were notes for medication refusal dated 10/5/23 , 10/9/23 and 10/12/23. Based on interviews, observations, and file review there was not enough supportive evidence to concur with the reported allegation. 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 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: 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)

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