198600539-10-24-2023-28-AS-TVAO-CXSPAP-20231121100902

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/24/2023
Date Signed: 10/24/2023 04:05:40 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
10/16/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231016125151

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: 147	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Christina Vasquez, Staff		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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1. Staff do not protect foods against contamination.
2. Staff do not distribute medications as prescribed.
3. Staff do not maintain facility in good repair.
4. Staff do not maintain facility clean and sanitary at all times.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Staff, Christina Vasquez. The purpose of the visit was explained.

The investigation consisted of the following:
LPA obtained a copy of the staff roster, client roster, and toured the facility. LPA also reviewed medications for 14 clients. Interviews were held with 7 Staff and 14 Clients. The administrator was not present, but a phone interview was conducted.

The investigation revealed the following:
Allegation – Staff do not protect foods against contamination. It is alleged that there are bugs in the kitchen which contaminate the foods. Per staff, they have not had any bugs in the kitchen area but sometimes get flies.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

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-20231016125151

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: 10/24/2023

NARRATIVE

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They set up fly traps to prevent them from getting into the foods. Staff stated they clean the counters before and after preparation of meals. During the visit today, LPA toured the kitchen. The kitchen appeared sanitized, and the cook was preparing lunch. The foods were covered and properly refrigerated. There were no roaches or other bugs observed in the kitchen to contaminate the foods. The perishables and non-perishable items have not expired. 13 out of 14 clients interviewed stated they do not feel the foods have been contaminated and have not seen any bugs in their foods.

Allegation – Staff do not distribute medications as prescribed. It is alleged that medications are missing and not distributed as prescribed. Per staff interviewed, the residents are taking their medications as prescribed. They come to the med room for their medications, and most clients are compliant. If they do not show, the staff will call their names via intercom or will go to their rooms to remind them. They document the medications in the back of the medication log when they are not in the facility or when they refuse. They request for refills a few days prior to medications running out. LPA reviewed medications for 14 Clients. Those are being administered as prescribed and indicated on the MAR logs. Refills have been obtained timely. Staff also documented when clients refused their meds or not in the facility. 12 out of 14 clients stated staff have given their medications daily and on time. One of the clients indicated staff did not obtain refills on timely so the medications were missed which occurred a few months ago, while another stated staff did not distribute the medication at the time indicated on the label.

Allegation – Staff do not maintain facility in good repair. It is alleged the intercom is on a loud system and can be heard outside even at night. Also, light bulbs need to be replaced throughout the facility. Staff interviewed stated when a client reports some thing in disrepair, they will inform the maintenance staff right away. They stated sometimes clients turn off the switch to the lights in the hallways and nothing is wrong with them. However, if it is determined the light bulbs need to be replaced, the maintenance staff will do as soon as possible. LPA toured the facility today. The intercom system was set at a level which is not too loud or soft. LPA did not observe any lights that need replacement. 12 out of 14 clients stated the intercom speakers are not loud and the lights in the hallways are working.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231016125151

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: 10/24/2023

NARRATIVE

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Allegation – Staff do not maintain facility clean and sanitary at all times. It is alleged the garbage is leaving an odor of harmful substance. Administrator and Staff interviewed stated they are often cleaning the facility and do not leave foul smells lingering. They stated if there is any odor, they will try to locate where it is coming from. They will clean it up if it is on the floor or address it with the client right away to reduce the smell. Trashes are taken out daily in the common area and rooms. They also have air fresheners placed throughout the facility. During the visit today, LPA did not smell anything malodorous or hazardous to the health. 13 out of 14 clients have not smelled anything malodorous around the facility. They stated housekeepers are often cleaning and take out their trash daily.

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 allegations are UNSUBSTANTIATED.

An exit interview was conducted with Staff Ms. Vasquez. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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