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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/13/2024
Date Signed: 02/13/2024 10:34:06 AM

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
02/06/2024 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240206100058
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:
02/13/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Andrew De-Vera - Administrator TIME COMPLETED:
10:48 AM
ALLEGATION(S):
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Facility staff mismanaged client's medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Andrew De-Vera and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff and client roster, conducted a tour of medication room, interviewed 8 clients and 5 staff, and requested copies of training certificates for staff.

The investigation revealed the following: Regarding allegation: Facility staff mismanaged client's medication. It is alleged client’s medication was provided in a wet cup and counter where the medication is placed is constantly wet causing medications to become wet. Interviews with clients revealed 7 out of 8 clients have not have any issues with their medication or observed water in their medication cup. A few clients mentioned that even if the countertop was wet the medication cannot get wet because it is in a plastic cup. 1 out of 8 clients stated water has been observed in the countertop and staff do not dry it and it's closed to the medication . (CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
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-20240206100058
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: 02/13/2024
NARRATIVE
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Interviews with staff revealed medication gets prepared at night and placed into plastic cups. The medication cups are then stored in the closet in trays, each cup is label per client. Staff provide a separate cup for the client’s water which is prepare in the morning. Staff also stated that the medication counter does get wet when clients spill water from the water cups. However, they quickly dry the counter top with paper towels. During the visit LPA observed the medication cups separate from the water cups and counter top was observed dry. Staff last medication training was received on August 15, 2023.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) 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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2