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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 12/22/2023
Date Signed: 12/22/2023 02:27:11 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
12/18/2023 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20231218111344
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: 144DATE:
12/22/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Andrew De-Vera - Interim AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not provide safe environment for client.
Staff members did not afford client respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced initial 10-Day complaint investigation regarding the above allegations. LPA explained the purpose of today's visit to Interim - Administrator Andrew De-Vera who assisted with this visit.

The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters, interviewed Staff 1 to Staff 4 (S1 to S4), Client 1 to Client 14 (C1 to C14). Reviewed C1's file and obtained the copies of relevant documents.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
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 3
Control Number 28-AS-20231218111344
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: 12/22/2023
NARRATIVE
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Regarding allegation, Staff did not provide safe environment for client, it was alleged that staff screaming into the speaker. That loudness is “painful” to client ears.

Interviewed staff denied the allegation. They stated that staff never screaming into speaker and speaker volume is not too loud to the point that it will be painful to clients ears. Staff stated that there is only one client that continuously makes complaints about the intercom speaker volume. They stated that speaker volume adjusted to the point that clients can hear all announcements. Staff use the speaker to make sure that clients are taking their medications, inform them of their meals or they have a phone calls or visitors. Staff also stated that there are clients that complaints about volume of speaker being low, and they cannot hear their names when staff called them for medications or for meals. (13) out of (14) Interviewed clients stated that they don't have any concerns about the volume of the intercom system, and it does not cause them any pain. Also, they stated that staff not screaming into speaker. (1) client stated that volume has to be loud enough for everyone to hear announcements. (1) out of (14) clients stated that staff screaming into speaker and volume of the speaker cause pain in their ears. At the time of visit there were a few announcements at the facility and LPA did not observe that staff screaming into the speaker. LPA did not observe any clients complaining or expressing any concerns or informing staff that they were in pain due to the volume of the intercom system.

Continue 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
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 3
Control Number 28-AS-20231218111344
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: 12/22/2023
NARRATIVE
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Regarding allegation, Staff members did not afford client respect, it was alleged that staff got in client face when client has a conversation with another client.

LPA interviewed the staff, they all denied the allegation and stated they afford clients with respect. They also stated they would never get in client face when client has a conversation with another client. Interviewed S2 and S3 stated they always afford clients with respect and never get in clients face during the conversation. Staff also stated they never seen any staff was being disrespectful and not treated clients with dignity. (13) out of (14) clients stated that staff are respectful and afford them with respect, never seen that staff got in clients face. (1) out of (14) client stated that staff are talking to fast. Client had no other concerns. Client mentioned that facility is safe place for them.

Based on interviews and observations conducted there was not enough supportive evidence to concur with the reported allegations. 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 allegations are UNSUBSTANTIATED.

Exit interview conducted. A copy of the report was provided to Interim - Administrator Andrew De Vera.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
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: 3 of 3