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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 11/16/2023
Date Signed: 11/16/2023 02:16:28 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
11/07/2023 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231107135709
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: 140DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:Andrew De Vera - AdministratorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff do not ensure client has access to personal hygiene care.
Staff does not ensure client is provided with fresh linens.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above stated allegations. LPA met with Andrew De Vera, Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Client & Staff Rosters, Braun Laundry/Linen invoice service invoices (Apr. 2023-Oct. 2023), Dewey Pest Control service agreement and invoices (May 2023-Sep 2023), Routine Medication Sheets for six (6) random clients, Housekeeping schedule . Between 10:50am-11:45am, LPA conducted a tour of the facility, including common areas, personal hygiene/ linen supplies area, Administrative office, outside patio and inspected eleven (11) random client rooms in the 1st and 2nd floors (Room #s: 105, 206, 108, 111, 114, 207, 208, 212, 26, 27 and 29). LPA interviewed Staff #1 (S1) - Staff #6 (S6). LPA was unable to interview Staff #7 (S7) as she left due to an emergency. LPA also interviewed Client #2 (C2) - Client #12 (C12) and attempted to interview Client #1 (C1) 2x but unsuccessful. Ist attempt was at 11:30am but C1 was taking a nap, and 2nd attempt was at 12:31pm, but C1 refused to speak with LPA. *****CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
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-20231107135709
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: 11/16/2023
NARRATIVE
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The investigation revealed the following:

In regards to the allegation: Staff do not ensure client has access to personal hygiene care, it is alleged that the staff are not replenishing R1’s hygiene products like hand soap, shampoo, toothbrushes, toothpaste, toilet paper and clean fresh towels for the bathroom. Staff interviews revealed that the clients are provided with hygiene supplies as needed. Interviewed staff indicated that most clients buy their own personal hygiene supplies because they prefer specific brands, however, if client asks for additional supplies, they provide them and have never refused clients. Per staff interviews, clients are provided with shampoo, conditioner, body wash, toilet paper, toothbrush, toothpaste, deodorant, razors and laundry soap. During the room inspections, LPA observed clients bathrooms have enough personal hygiene supplies. Interviewed clients stated that housekeepers provide them supplies all the time, whenever they ask. Some clients stated that they buy their own shampoo and conditioner but if they need more, they were never denied of hygiene supplies if they ask. LPA also observed sufficient basic hygiene supplies stored in the facility’s storage cabinet. Staff and clients interviews and LPA's observation do not corroborate this allegation.

In regards to the allegation: Staff does not ensure client is provided with fresh linens, it is alleged that the staff are not replenishing R1 with clean fresh towels for the bathroom. Staff interviewed denied the allegation. Interviewed staff stated that housekeepers do their room checks daily to take the trash out, replenish supplies like toilet paper and change clients bathroom towels on a daily basis or as needed. Interviewed clients stated that housekeepers provide them clean and fresh towels on a daily basis. LPA toured the facility and inspected the linen closets and observed sufficient supply of bath towels. During the room inspections, LPA also observed clients bathrooms to have clean towels. Staff and clients interviews and LPA's observation do not corroborate this allegation.

Based on statements and interviews conducted with staff, clients and LPA's observations, there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview conducted and a copy of this report was provided to Bertha Torres, Med Tech.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2