198600539-1-5-2024-28-AS-RORN-CZDRWX-20240111122350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/05/2024
Date Signed: 01/05/2024 03:26:22 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
01/02/2024 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20240102121811

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: 146	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Andrew De-Vera		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff do not ensure the clients have clean linen.
Staff do not provide medication information to a client.
Staff have not repaired the washer and dryer.

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 5 (S1 to S5), Client 1 to Client 8 (C1 to C 8), obtained the copies of relevant documents.
Staff 5 (S5) was interviewed over the phone. LPA additionally conducted a tour of the facility which included observations of a common areas, random selection of client rooms in both buildings A and B and laundry rooms in both buildings A and B.

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: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240102121811

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: 01/05/2024

NARRATIVE

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The investigation revealed the following: Staff do not ensure the clients have clean linen. It was alleged that clients don’t have clean linens.

LPA interviewed 5 staff (S1-S5), and all denied the allegation. They stated that housekeepers clean the rooms daily and clean the linens weekly and as needed. Staff would change linens any time when client requested. LPA interviewed 8 clients( C1-C8) , they all reported their bed has all required linens including pillowcase, mattress pad, fitted sheet and staff provide towels and other supplies needed. They stated that the rooms are cleaned daily, and they are provided with clean linen once a week and as needed. At the time of visit LPA observed 4 areas in the facility to store clean linens. Interviewed Interim Administrator stated that facility have a contract with the Linen Company / Braun to clean and supply facility linens. Company comes twice a week for pickup and drop off. LPA also inspected randomly chosen rooms and observed they all have required linen and in good repair. Staff and clients interviews and LPA's observation do not corroborate this allegation.

Staff have not repaired the washer and dryer: It was alleged that the washer and dryer is not working.

Interviewed 5 staff (S1-S5) denied the allegation. They stated that there is no problem with washer and dryer machines, and they are operating well. Staff will bring on management attention if there are any issues with the machines and will directing the clients to the laundry room of appliances that are working. LPA toured the facility and observed 4 laundry rooms at the facility. Side A bottom floor room has 2 washers / 2 dryers, top floor room has 2 washers / 2 dryers and Side B bottom floor has 1 washer / 1 dryer, top floor room has 1 washer / 1 dryer. All machines appeared to be working at the time of visit. LPA observed that clients are doing laundry and there weren’t any issues with washers and dryers. Interviewed 8 clients (C1-C8) stated that washer / dryer machines are working and they able to use them. They stated when washers or dryers not working, they will report it to the staff and machines will be fixed in a timely manner. They stated that there are always working machines at the facility and don't have concerns about this matter. Staff and clients interviews and LPA's observation do not corroborate this allegation.

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NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240102121811

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: 01/05/2024

NARRATIVE

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Staff do not provide medication information to a client. It was alleged that staff did not give information about client medication.

4 out of 5 Interviewed staff denied the allegation. 1 staff (S4) had no information about clients medications. Staff that administer medications (S3, S5) indicated they only administered medications that have a doctor’s orders and each clients has information about their medications. Interim Administrator and staff stated that all clients have a right to ask what medication they are taking, and they have a right to see their MAR. There are Routine medications and PRN medications for the clients. All Routine medications are administrated on time per doctor's order. For PRN medications staff has to document what clients are feeling, before administrating the medication. Staff also check PRN medication order to see if okay to give per time limitation. All interviewed clients (C1- C8) stated that they take their medications daily and have information about the medications that they are taking. Staff do not administer any medication that are not ordered by their doctor.Staff and clients interviews do not corroborate this 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.

An exit interview was conducted with Interim Administrator, Andrew De-Vera, and copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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