198600539-1-16-2024-28-AS-FFIS-D5PMQ9-20240528094817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/16/2024
Date Signed: 01/16/2024 02:45:22 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
01/11/2024 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240111111213

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: 144	DATE:	01/16/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Staff Andrew De Vera		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Facility is unkempt.
Staff does not ensure facility is free from roaches.
Staff mismanaged medication.
Staff does not provide adequate food service.
Facility does not have hot water.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) above. LPA met with staff Andrew De Vera and the purpose of the visit was discussed.

LPA conducted the following on todays visit: Toured the physical plant with a random sample of client rooms, Interviewed staff #1-#5 (S1-S5), interviewed clients #1-10 (C1-C10), and reviewed medications for a random sample of (10) clients. LPA reviewed and collected a copy of the staff and client rosters as well as the records of pest control and food menu for the last 3 months. The investigation revealed the following:

In regards to the allegation "Facility is unkempt." it was alleged that the facility is dirty. (5) of (5) Staff interviewed denied the allegation. (10) of (10) Clients interviewed could not corroborate the allegation. Interviews with staff and clients show that staff will repeatedly clean the facility everyday...

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

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-20240111111213

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: 01/16/2024

NARRATIVE

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Clients interviewed stated that when they let staff know about a mess, the staff will address the issue and clean it. LPA toured the physical plant in the AM and did not observe the facility to be unkempt or dirty. LPA observed (3) housekeeping staff on shift cleaning rooms and the common areas during the visit. Based on file review, observations and interviewed conducted; 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 allegation is Unsubstantiated.

In regards to the allegation "Staff does not ensure facility is free from roaches." it was alleged that rooms have roaches and staff do not ensure to keep the facility free from roaches. (5) of (5) Staff interviewed denied the allegation. (10) of (10) Clients interviewed could not corroborate the allegation. LPA toured random client rooms such as rooms #2, #7 , #30 , #32 , #36 ,#204, #215, #217, #224 and #226 and did not observe roaches. Interviews show that the facility has a contract with a pest control company in place for addressing insects such as roaches. LA conducted a file review of the last 3 months of services provided to the facility demonstrating a plan from the facility to address pest issues. Based on file review, observations and interviewed conducted; 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 allegation is Unsubstantiated.

In regards to the allegation "Staff mismanaged medication." it was alleged that staff did not give a client the correct medications. (5) of (5) Staff interviewed denied the allegation. (10) of (10) Clients interviewed could not corroborate the allegation. LPA reviewed (10) clients medications and did not observe notes or errors of wrong medications being dispensed. LPA did not observe incident reports of wrong medications being dispensed to clients in care. Clients interviewed stated staff have not given out the wrong medications to clients. LPA was not provided with proof that staff provided clients in care the wrong medication. Based on file review, observations and interviewed conducted; 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 allegation is Unsubstantiated.

Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240111111213

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: 01/16/2024

NARRATIVE

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In regards to the allegation "Staff does not provide adequate food service" it was alleged the facility has kept the same food menu every week since 2022 as well as the kitchen being dirty and there not being enough food. (5) of (5) Staff interviewed denied the allegation. (10) of (10) Clients interviewed could not corroborate the allegation. File review of the last 3 months food menus shows that there are various weekly food menus followed by the facility. Interviews with staff and clients show that there have even been recent changes to the menus after the clients started their resident councils and met with staff. LPA observed the kitchen and food available in the facility. The kitchen was clean and LPA observed a sufficient amount of food for 7 day non perishables and 2 days worth of perishables foods to meet client needs. Based on file review, observations and interviewed conducted; 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 allegation is Unsubstantiated.

In regards to the allegation "Facility does not have hot water" it was alleged sometimes there is no hot water. (5) of (5) Staff interviewed denied the allegation. (10) of (10) Clients interviewed could not corroborate the allegation. LPA was not provided with an example of where and when the facility has not had hot water. LPA inspected the water temperatures for the bathrooms in rooms #2, #7 , #30 , #32 , #36 ,#204, #215, #217, #224 and #226. Water temperatures were measured within Title 22 regulations. Interviews with clients did not show that there were issues with the hot water in the facility. Based on file review, observations and interviewed conducted; 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 allegation is Unsubstantiated.

Exit interview conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024

LIC9099 (FAS) - (06/04)

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