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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/07/2024
Date Signed: 02/07/2024 02:51:28 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
02/01/2024 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240201144100
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: 143DATE:
02/07/2024
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Staff Andrew De Vera TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are withholding resident’s personal funds.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation above. LPA met with Staff Andrew De Vera and the purpose of the visit was discussed.

On todays visit, LPA interviewed Staff #1-#3 (S1-S3) and Clients #1-#8 (C1-C8). LPA toured the physical plant. LPA also collected and reviewed the following documents: staff and client roster, C1's physicians report, C1's Facesheet, C1's admissions agreement, and C1's Record of Safeguarded Cash resources going back to 6/1/2022. The investigation revealed the following:

In regards to the allegation "Staff are withholding resident’s personal funds" it was alleged that the facility staff did not want to provide C1 with their personal funds when they asked for it. (3) of (3) Staff interviewed denied the allegation. (7) of (8) Clients interviewed could not corroborate the allegation....

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: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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-20240201144100
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: 02/07/2024
NARRATIVE
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 Interviews with staff stated that C1 does not receive their personal funds into their bank account until the 1st or second of each month. When C1 requested their money for the month of February, it was still the last day of January (1/31/24) and the money was not available. Staff interviewed denied that they refused to provide C1 their money but that C1 was informed that there money would be provided once it arrived for the new month. Interview with C1 stated that they understood why they did not receive their money on 1/31/24 but from now on wanted to get it on the 1st day or 3rd day of each month at the latest. Interviews also show that C1 had a conversation with staff that C1 would wait to collect their money until 2/7/24. LPA observed C1 collecting their money with no issues during the visit. LPA observed C1's file showing that C1 will collect their personal funds in full from the facility each month. LPA was not provided with proof that staff were withholding any of C1's personal funds. Based on interviews, file review, and observations conducted during the visit; 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.

Exit interview was conducted with Andrew De Vera 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: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2