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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 01/29/2024
Date Signed: 01/29/2024 02:47:31 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
08/19/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220819155121
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:
01/29/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH: Staff Andrew DeveraTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not properly trained.
Facility does not have adequate food supply.
Staff are not providing toiletries to residents as needed.
Facility has pests.
Staff do not provide a comfortable temperature for residents.
Resident's rooms are dirty.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent unannounced complaint visit in response to the above mentioned allegation(s). LPA Villalobos met with Staff Andrew Devera and explained the purpose of the visit.

During today's visit, LPA toured the physical plant and rooms #'s 29, 35, 46, 47, 58, 113, 114, and 219. LPA interviewed Staff #1-6 (S1-S6) and clients #1-10 (C1-10). LPA reviewed and collected copies of documents from C1's file.

Additionaly LPA has interviewed Staff #7-8 (S7-S8) and Clients #11-12 (C11-C12). LPA reviewed and collected copies of pest control and repair documents between June 2022-August 2022. LPA toured the physical plant and observed the food supply. The investigation revealed the following:

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: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
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 3
Control Number 28-AS-20220819155121
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: 01/29/2024
NARRATIVE
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In regards to the allegation "Staff are not properly trained" it is alleged that S3 does not have proper training to hand out medications. (8) of (8) Staff interviewed denied the allegation. (12) of (12) clients interviewed could not corroborate the allegations. Interview with S3 stated that they are trained in handling medications so that during the PM shift, S3 is able to assist the other med techs in providing clients their medications. Interviews conducted show that S3 does provide assistance with medications while also providing assistance to the cooks during meal times. LPA reviewed S3's file and observed training certifications on medication management. Based on interviews, files reviewed and observations conducted ; although the allegation 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Facility does not have adequate food supply" it is alleged that the facility does not have enough supply to make meals for residents. (8) of (8) Staff interviewed denied the allegation. (12) of (12) Clients interviewed could not corroborate the allegation. Interviews with staff state that food is purchased and delivered 2 times a week to make sure there is always food on hand for the clients. Staff stated that clients are not refused meals at anytime. Clients interviewed stated to be provided 3 meals a day along with snacks and coffee being available. LPA Villalobos observed adequate food supply in the facility. Based on interviews, files reviewed and observations conducted ; although the allegation 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff do not provide a comfortable temperature for residents" it was alleged that the air conditioner does not function and the facility becomes too hot for the clients. (8) of (8) Staff interviewed denied the allegation. (10) of (12) Clients interviewed could not corroborate the allegation. Interviews conducted show that there were some issues in random rooms of the facility that had air conditioning problems during the summer of 2022. Staff interviewed stated that companies were contacted throughout the summer to conduct fixes and inspections on the facilities AC system. LPA observed work orders dated 7/7/22 and 8/17/22 showing repairs done to the parts of the AC system in the facility including rooms #109 and #215. Staff interviewed stated the matter was not ignored and was addressed as soon as possible to the rooms that affected. LPA observed comfortable temperature throughout the facility on both visits conducted. Based on interviews, files reviewed and observations conducted ; although the allegation 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 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: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220819155121
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: 01/29/2024
NARRATIVE
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In regards to the allegation "Facility has pests" it was alleged that there are clients rooms with bed bugs and the staff do nothing about it. (8) of (8) Staff interviewed denied the allegation. (12) of (12) Clients interviewed could not corroborate the allegation. Interviews show that staff had reported to have observed bed bugs in client rooms and address it. Interviews with staff also stated bed bug treatments along with other pests are actively conducted by the pest control company the facility contracts. LPA did not observe any bed bugs in the client rooms entered. LPA Villalobos reviewed pest control invoices for Dewey Pest Control for 6/1/22 through 8/1/22. Interviews stated that when clients inform staff of any pests, the staff will contact pest control and provide assistance. Based on interviews, files reviewed and observations conducted; although the allegation 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff are not providing toiletries to residents as needed" it was alleged housekeeping staff are not providing toiletries. (8) of (8) Staff interviewed denied the allegation. (12) of (12) Clients interviewed could not corroborate the allegation. Staff interviewed stated that it is part of the housekeeping staffs duty to refill and provided toiletries to clients in care. Staff interviewed also described that as housekeeping go into client rooms to clean, they will provide new toiletries to each room. Clients interviewed corroborated that information and added that they can also go up to housekeeping staff and ask for any toiletries they need. LPA observed client rooms to have required toiletries. Based on interviews, files reviewed and observations conducted ; although the allegation 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Resident's rooms are dirty" it was alleged that there are no housekeepers cleaning the rooms. (8) of (8) Staff interviewed denied the allegation. (12) of (12) Clients interviewed could not corroborate the allegation. Interviews with staff state that that there are housekeeping staff on each shift. Staff will go to each clients room to provide the following: cleaning rooms, taking out the trash, providing new toiletries. Interviews with staff state that the only time a clients room is not cleaned is when the client themselves deny the staff entry and tell the housekeeping staff to go away. LPA did not observe dirty rooms during the tour. Clients interviewed stated that housekeeping staff clean around the facility and client rooms all day. Based on interviews, files reviewed and observations conducted ; although the allegation 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 allegation is UNSUBSTANTIATED.

Exit Interview conducted and 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: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3