198600539-1-5-2024-28-AS-FFIS-CZE2ZU-20240111165056

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 12/19/2023
Date Signed: 01/05/2024 11:46:04 AM

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
12/14/2023 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231214094117

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: 162	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Andrew DeVera- Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not prevent resident from being bullied by another resident
Staff did not provide a safe and comfortable environment

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

*Please note: This licensing report has been amended to remove quotes used, that may be considered confidential information.*
Licensing Program Analyst (LPA) Nune Margaryan made a subsequent unannounced visit at the facility to deliver an amended licensing report. LPA met with Andrew De-Vera and the purpose of the visit was explained.
On 12/19/23, LPA V. Maldonado made an unannounced initial complaint visit to facility, for the purpose of investigating the above-mentioned allegations. LPA Maldonado met with Administrator, Andrew De Vera, and explained the purpose for the visit. During the visit, LPA Maldonado obtained a copy of the resident and staff roster and conducted interviews with Staff# 1-3 (S1-S3) and attempted to interview Clients# 1-7 (C1-C7). The investigation revealed the following:
Regarding allegation: Staff did not prevent resident from being bullied by another resident.
It is alleged that on an unknown date, a client spat on another client’s shirt, and a client observed another client punching a client twice on separate dates, and that on 12/14/23, a client made a comment towards another client that was hateful and bad. However, no further details were provided.
(Report Continued LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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-20231214094117

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: 12/19/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Per staff interviews, (3) of (3) staff denied C1 or other clients reporting to staff that another client had spat on them, talked to them in an inappropriate manner, or hit another client. Per client interviews, (5) of (7) clients denied the allegation of clients bullying other clients. LPA was unable to interview C7 due to C7 being out of the facility at the time of the visit

Regarding allegation: Staff did not provide a safe and comfortable environment.
It is alleged that an unknown client walks around the facility with their pants down, and although staff are aware, they do nothing about it. Per staff interviews, (3) of (3) staff denied clients walking around with pants down or clothing off. S1 and S2 stated that the allegation could possibly be regarding C7. They stated that C7 has weakness on one side of C7’s body and when C7 walks, C7’s pants slip down due to their walking impairment. However, staff have addressed this with C7 and have attempted to assist by purchasing clothes that may fit more appropriately. C7 does not pull their pants down purposely. LPA was unable to interview C7 due to C7 being out of the facility at the time of the visit. Per client interviews, (5) of (7) clients denied the allegation. Per C1, C1 saw (2) unknown individuals on unknown dates, with their pants down exposing their groin and back areas to C1. C1 reported that C1 believes the individuals were exposing themselves to C1 on purpose.

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.

Per California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit.

An exit interview was conducted with Administrator, Andrew DeVera, and copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2