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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 03:48:49 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
11/29/2023 and conducted by Evaluator Ashley Calderon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231129154942
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:
03:20 PM
MET WITH:Interm-Administrator - Andrew DeVeraTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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2
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5
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8
9
Staff do not provide adequate supervision to the clients.
INVESTIGATION FINDINGS:
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2
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5
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7
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9
10
11
12
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, LIC500 and LPA Calderon conducted a tour in room Room 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 do not provide adequate supervision to the clients. Interviews with clients revealed (15) out of (15) clients informed LPA that there is sufficient staff who adequately supervise clients in care. Interviews conducted (5) out of (5) staff stated there is adequate supervision provided to the clients at the above facility. LPA reviewed LIC500 facility had adequate staffing. (Continuation 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-20231129154942
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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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