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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 11/30/2023
Date Signed: 11/30/2023 03:52:25 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
11/28/2023 and conducted by Evaluator Ashley Calderon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231128084408
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: 147DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Interm-Administrator - Andrew DeVeraTIME COMPLETED:
03:19 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff does not ensure resident is spoken to in an appropriate manner
Staff does not ensure resident is accorded a comfortable pillow for their bed.
INVESTIGATION FINDINGS:
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5
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9
10
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13
Licensing Program Analyst (LPA) Ashley Calderon made an unannounced complaint visit. LPA upon arrival was greeted by Marketer Christina Vasquez and later was met with Interm-Administrator Andrew DeVera and discussed the purpose of today's visit.

During today's visit, LPA obtained a copy of the Staff/Client roster and LPA Calderon conducted a tour in rooms: 2,9,15,16,18,19,23 and 24 with Christina Vasquez. The investigation consisted of client interviews C1-C15 and staff interviews Interm-Administrator and S1-S4.

In regards to the allegation: Staff does not ensure resident is spoken to in an appropriate manner. Based on interviews conducted with client's (13) out of (15) clients informed LPA that staff speak appropriately over the intercom when speaking to residents and residents are spoke to in an appropriate manner. Interviews with staff revealed (4) out of (5) staff informed LPA staff ensure residents are spoken to appropriately. LPA observed during time of visit varies occasions were the intercom was used and staff spoke appropriately. (Contnuation LIC9099-C...)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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-20231128084408
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: 11/30/2023
NARRATIVE
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In regards to the allegation: Staff does not ensure resident is accorded a comfortable pillow for their bed. Based on interviews conducted with client's (12) out of (15) clients informed LPA Calderon that the are fine with the pillow they have and it is comfortable to met their needs. Interviews with staff (4) out of (5) staff members informed LPA that pillows should be comfortable and staff are ensuring pillows are comfortable. LPA did random room checks and observed occupied client's rooms having pillows for 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 allegation is UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Interm-Administrator Andrew DeVera, a copy of this report will be provided via email.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2