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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 09/25/2023
Date Signed: 09/25/2023 02:48:41 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
09/21/2023 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230921142924
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: 145DATE:
09/25/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Andrew De-VeraTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not provide resident with medical assistance
Staff are not providing adequate food service to residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Andrew De Vera and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Andrew De Vera, Staff 1-4 (S1-4) and Clients 1-14 (C1-14). LPA collected copies of Staff and Client Rosters and facility food menus from 07/09/23 - 09/30/23. LPA additionally conducted a tour of the facility. The tour included observations of outside patio, medication room, facility lobby, dining room and kitchen which included facility food storage.


(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
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 3
Control Number 28-AS-20230921142924
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: 09/25/2023
NARRATIVE
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Investigation revealed the following: Regarding allegation, Staff did not provide resident with medical assistance, it is alleged that a client was choking on something hard in the food they were eating and when this happened facility staff did not come to help the client. The client had to allegedly cough up the food item. Staff are allegedly too busy on their phones to help clients. It is also alleged that staff scream out clients names in an inappropriate manner and also criticize clients by intervening in their private conversations. It is additionally alleged that staff also make inappropriate comments to clients and the speaker volume is too loud in the morning and the speaker volume goes up and down throughout the day to the point that it hurts client's ears. Interviews conducted with facility staff revealed that staff provide all clients with medical assistance when needed. They stated that staff provide first aid and if a client requires a higher level of medical care they will call 911 so that the client can be properly treated at a hospital or urgent care. Staff also stated that they assist clients when they need any type of help and denied that due to being on their private phones they are not assisting facility clients. Staff stated that they do call out clients names as needed but never in a tone that might be interpreted as inappropriate or as a scream. Staff deny criticizing any client and denied intervening in clients private conversations. Staff deny that the speaker is too loud to the point it hurts clients ears. Staff stated that some clients complain about the volume being too low and they are not able to hear when staff are calling them. 13 out of 14 clients stated that staff do provide clients with medical assistance when it is needed. They stated that staff are not always on their phones, staff are helpful and professional and they do not make inappropriate comments to clients. They also stated that they are satisfied with their relationships with staff and that staff are very helpful with anything they might need. 13 out of 14 clients stated that they have no concerns over the intercom speaker being too loud. 2 out of 14 clients stated that the speaker is too low at times and they have trouble hearing the notifications. LPA conducted a tour of all facility which included common areas, kitchen, outside patio, facility lobby, and dining room and while conducting the tour did not observe that the speaker system is too loud. LPA also observed staff and did not observe or hear any staff speak inappropriately to clients. LPA observed staff tending to clients needs. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff are not providing adequate food service to residents, it is alleged that the facility served raw bacon, the coffee is rotten/ expired and the pancakes are sour. Interviews conducted with facility staff revealed that food is not served raw facility clients. Staff deny that coffee is expired and/ or rotten and stated that they have not heard any clients state that the pancakes taste sour. Kitchen staff stated that the
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230921142924
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: 09/25/2023
NARRATIVE
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food that is served to clients is not expired and stated that the facility food consumption calls for a weekly order. Kitchen staff stated that the food never sits in storage long enough to expire, they label the food with the date of when it is stored and also highlight the expiration date. Interviews conducted with 12 out of 14 facility clients stated that they are satisfied with the food service and stated that food is served fully cooked and not raw, the coffee does not taste rotten and or expired and the pancakes do not taste sour. 2 clients stated that the pancakes taste sour. 2 clients stated that they prefer to eat outside of the facility but do eat at the facility sometimes and they do not have any complaints. During the time of the visit, LPA observed facility food storage and observed that the food is not expired. LPA observed food to be labeled properly with the date that the food was received/ stored at the facility as well as clearly highlighted expiration dates. LPA also observed required amount of perishables and non-perishables. Based on statements gathered from interviews conducted with staff and clients, as well as LPA observations there was not enough supportive evidence to concur with the reported allegation.

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 held. A copy of the report was provided to Assistant Administrator Christina Vasquez.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3