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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:54:25 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/16/2024 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240116135540
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: DATE:
01/19/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Andrew De-VeraTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff do not ensure the food being served is of good quality.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wong conducted an initial 10 days complaint visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with Staff #1 Medication Supervisor Julia Elias who allowed entry into the facility and assisted with the visit. Shortly after, the Assistant Administrator Andrew De-Vera arrived.

The investigation consisted of the following: On today's date, LPA interviewed fourteen (14) clients, administrator and four (4) staff (S1-S4) in the facility and two (2) staff (S5-S6) via telephone. LPA also toured the kitchen and observed clients' lunch for today and obtained documents included: client and staff roster and the facility menu.

(See LIC 9099C for continuation)

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
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-20240116135540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PICO RIVERA GARDENS
FACILITY NUMBER: 198600539
VISIT DATE: 01/19/2024
NARRATIVE
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The investigation revealed of the following: "Staff do not ensure the food being served is of good quality. " LPA interviewed fourteen (14) clients and twelve (12) out of fourteen (14) clients denied the allegation and reported the food is getting a lot better because they changed the new cook and the menu and now the food has more flavor and higher quality. LPA interviewed the staff and six (6) out of six (6) staff denied the allegation and reported they did not receive any complaints from clients about food lately. Staff reported that they only heard clients' compliment about the new cook but no complaints. LPA observed today's lunch and did not observe poor quality food. LPA also toured the facility kitchen and observed all the food are stored properly and the facility has ample supply of food for two days perishable and seven days non-perishable food. LPA also checked all the food items in the pantry and refrigerator and all of the food are within the expiration date.

Based on the interviews conducted with the staff and clients and documents reviewed and LPA's observation, 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 was conducted with Andrew De-Vera and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2