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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/08/2024
Date Signed: 02/08/2024 05:46:03 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
01/31/2024 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240131112541
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: 149DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Andrew DeVeraTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
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9
Staff spoke inappropriately to resident.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) listed above. LPA met with Acting Administrator Andrew De Vera to discuss the purpose for todays visit.

LPA toured the physical plant, interviewed residents #1-#15, staff #1, interviewed Administrator, and requested a copy of staff roster, resident roster, and requested information regarding staff #2.

Regarding allegation: Staff spoke inappropriately to resident. During the investigation it was discovered that R1 was referring to an incident that occured in 2021. The employee that they are speaking about has not worked in the facilty since July 2021. The incident regarding the bat and other two residents barfing at the resident also occured in 2021. There was also a complaint that the resident complained about the speakers being loud when a specific person was making the announcements. LPA Wesley requested for the
Continued on LIC 9099
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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-20240131112541
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: 02/08/2024
NARRATIVE
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system with the specific person on there and it was fine, wasn't loud and didn't hurt our ears. LPA interviewed fourteen residents and they indicated that the staff does not speak to them in an inappropriate manner.

Based on the interviews conducted with clients, staff and the observation of the announcement system the preponderance of evidence standard has not been met. 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 Administrator Andrew De Vera. A copy of this report along with the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2