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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/20/2023
Date Signed: 10/20/2023 11:19:02 AM

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
10/10/2023 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231010145905
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: 137DATE:
10/20/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andrew De VeraTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff did not prevent an altercation between residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) listed above. LPA met with Acting Administrator Andrew De Vera to discuss the purpose for todays visit.

LPA toured the physical plant, interviewed residents #2-#9 and staff #1-#2, interviewe Administrator, and requested a copy of staff roster, resident roster, and copy of specific items from resident #1(R1) file.

Regarding allegation: Staff did not prevent an altercation between residents. During the investigation it was revealed that staff were unaware that an altercation took place between R1 and R2. When R1 informed staff that he was slapped by R2 they asked if he want to file a police report and he declined. The resident didn't remember the name of the staff person or the name of the resident, so LPA Wesley interviewed some residents and they were all consistent in saying the staff does intervene when they or someone else has an
Continued on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
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-20231010145905
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: 10/20/2023
NARRATIVE
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altercation. Interviews with R3-R9 revealed that when a staff observes a fight between two residents, they intervene and asked them if they need assistance with filing a police report, medical attention, or if they are in need of a room separation.

LPA interviewed the staff who said they usually don't have physical altercations, have witnessed verbal, but they disengage the problem and if they don't have the ability the Sheriff are called.

Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegations are found to be Unsubstantiated.

A copy of this report was given to the Acting Administrator Andrew De Vera
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2