198600539-10-27-2023-28-AS-RORN-CZKNCW-20240117092122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 10/27/2023
Date Signed: 10/27/2023 02:43:41 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
10/24/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231024100706

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:	10/27/2023
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Andrew De Vera		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not prevent a resident from making inappropriate comments towards another resident
Staff do not treat resident with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wong conducted an “Initial 10-Day” visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with Administrator Andrew De Vera and allowed the entry of the facility and explained the purpose of the visit and assisted with LPA today's visit.

The investigation consisted of the following: On today's date, LPA interviewed fourteen clients (C1-C14), Administrator and six staff (S1-S6), LPA also obtained copy of documents which included: client and staff roster, C1 and C2's identification and emergency information, physician report and preplacement appraisal and the past two weeks staff communication log.

(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: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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-20231024100706

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: 10/27/2023

NARRATIVE

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The investigation revealed of the following: Allegation#1 "Staff did not prevent a resident from making inappropriate comments towards another resident" LPA interviewed 14 clients and 12 out of 14 clients reported staff usually would investigate the situation and resolve it immediately. They do not have any problems about the staff handled complaints or it never happened to them. LPA interviewed staff and they all denied the allegation and reported they would always access the situation and separate both clients if a client makes inappropriate comments and ask both clients to respect each other. They would also document on the staff communication log book too.

Allegation#2 "Staff do not treat resident with dignity and respect" LPA interviewed 14 clients and 12 out of 14 clients denied the allegation and reported all staff are respectful and treat them with dignity. No staff ever being mean to them. LPA interviewed the staff, they all denied the allegation and reported they would never hung up the phone with clients. Staff reported they always treat clients with respect and dignity. Staff also reported they never seen any staff was being disrespectful and not treated clients with dignity. During the interview, C1 recanted the statement about staff hung up the phone and stated not remembered if staff hung up the phone or not. Additionally, C1 also stated the alleged staff is nice and kind.

Based on the interviews conducted with clients and staff and recorded reviewed, 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 Administrator Andrew De Vera. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC9099 (FAS) - (06/04)

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