198600539-10-26-2023-28-AS-RORN-CZDMCT-20240111083002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/26/2023
Date Signed: 10/26/2023 04:17:49 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
10/19/2023 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20231019112508

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: 140	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Julia Elias		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not ensure that residents are being provided comfortable sleeping accommodations while in care.
Staff do not ensure that residents are being provided activities while in care.
Licensee does not ensure that the night staff are providing adequate care to residents in care.
Facility did not have hot water.
Facility is in disrepair.
Facility has pest infestation.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced 10 day complaint visit to investigate the allegations listed above. LPA met with Julia Elias. Administrator Assistant arrived shortly after and assisted with the visit. The reason for the visit was explained.

The investigation consisted of the following: Interview(s) with Assistant Administrator, Staff #1 - Staff #5
(S #1 - S #5), Resident #1- Resident #15 ( R #1 - R #15), obtained copies of staff and residents roster, maintenance log, activity calendar for month of September and October, night shift schedule, reports and invoices from Dewey Pest control company and GNA maintenance company, tour of facility, including common areas, patio area and randomly chosen resident rooms.

Cont. 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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 4

Control Number 28-AS-20231019112508

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: 10/26/2023

NARRATIVE

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Allegation: Staff do not ensure that residents are being provided comfortable sleeping accommodations while in care. It was alleged that Residents are sleeping inadequate and inappropriate conditions. Pictures received via email. On the pictures unknown resident is sleeping in the common area / telecare room on the mattress.
Interviewed staff stated Facility provides comfortable sleeping accommodations to all residents in care. They stated there is one resident (R #15) who sleeps everywhere, in the telecare room or in the TV room on the sofas. Sometimes R #15 bring the mattress from the trash beans located outside of facility / parking area. When staff is noticing that R15 is sleeping in the telecare room or in the TV room they telling R15 to go to his/her room and taking the mattress out. 14 Interviewed residents denied the allegation and stated they sleep in adequate and appropriate conditions. 1 resident stated that he/she likes to sleep in the telecare room, but it is nothing wrong in his/her room.

Allegation: Staff do not ensure that residents are being provided activities while in care. It was alleged that
staff do not ensure that residents are being provided activities while in care and Activity room locked during the day. Interviewed administrator and staff denied the allegation. They stated that Activity room open most of the time during the day and residents are participating in the activities. Interviewed Activity coordinator stated that there are group and individual activities for the residents and they are enjoying the activities. They have different activities every day. LPA reviewed Activity calendar for past 2 months which conformed that staff provide different activities to the residents. Interviewed resident denied the allegation. They stated that they like to participate in the activities and Activity room is open most of the time.

Allegation: Licensee does not ensure that the night staff are providing adequate care to residents in care.
It was alleged that staff falling asleep on the job, Inadequate night staff supervision.
Interviewed Assistant Administrator and staff denied the allegation. They stated that facility has enough staff to supervise the residents and provide adequate care to residents in care. They assist residents with all their needs all day and night. Facility has a 3 shift scheduled for morning , day and night. LPA reviewed the schedule and it show there to be coverage 24 hour a day. Interviewed residents stated that there is always night shift staff at the facility. Interviewed staff denied that staff falling asleep on job.

Cont. 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20231019112508

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: 10/26/2023

NARRATIVE

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Allegation: Facility did not have hot water. It was alleged at the facility no hot water every few days. Water shortage due to drilling next door.
All interviewed staff denied the allegation. They stated that Facility has a hot water and there is no issue with that. Administrator stated there is ongoing construction happening nearby but it's unrelated to the hot water at the facility. During the tour of the facility LPA measured water temperature at the restrooms in the common area and at the residents rooms. LPA observed all faucets and showers delivering hot water and the hot water temperature was between 112.1 F to 116.3F. Interviews with residents stated there are no current issues with the hot water of the facility.

Allegation: Facility is in disrepair. It was alleged that common area restrooms unsanitary, broken doors and fixtures, Neither central air-conditioning nor heat working. During the tour of the facility LPA didn’t observe any broken doors and fixtures. LPA observed common area restrooms to be clean, sanitary and in good repair. Interviewed staff denied the allegation. Staff stated that facility not in disrepair and all restrooms are clean, sanitary and operational. All restrooms cleaned on a daily basis. Any broken items at the facility will be fixed or will be replaced with new ones. Interviewed residents denied the allegation and reported the facility restrooms are clean and sanitary. They stated that if something breaks or does not work, they let staff know and they immediately fix it and remove any broken item and replace it. Interviewed staff stated that A/C works throughout the facility. During tour of the facility LPA observed the facility has central air conditioning throughout the facility and temperature was not too hot or too cold. Interviewed residents stated air conditioning is working and it maintains a good temperature.

Cont. 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20231019112508

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: 10/26/2023

NARRATIVE

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Allegation: Facility has pest infestation. It was alleged that mosquitos near congregated water.
During the tour of the facility, LPA didn’t observe any congregated water near the facility or in the outdoor / patio areas, which can cause mosquitos / pest infestation. LPA didn’t observe mosquitos or any pests in the facility common areas, outdoor / patio areas. LPA also didn’t observe any mosquitos in the residents’ rooms.
Interviewed staff denied that there are mosquitos / pests in the facility.. Assistant Administrator stated that the pest control company is coming every month. LPA reviewed the Dewey Pest Control Co. reports and invoices which confirmed Assistant administrator's statement. Last visit was on September and there was no
pests infestation reported. 14 out of 15 residents stated that they do at times see mosquitoes but only outside of the facility during the summer months, however they do not consider it to be an issue. 1 out of 15 resident stated that there are mosquitos at the facility's common areas but not in their room.

Based on the observations and interviewed conducted with staff and clients, Although the allegations 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 conducted and a copy of this report was provided to Assistant Administrator .

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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