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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/15/2024
Date Signed: 02/15/2024 02:35:08 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
02/12/2024 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240212162321
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:
02/15/2024
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Andrew DeVera - Administrator TIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff spoke inappropriately to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint investigation regarding the above allegation. LPA met with Administrator 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, self-toured facility to interview clients (total of 11 clients were interviewed during visit), and LPA intrerviewed 4 staff.


(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
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-20240212162321
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: 02/15/2024
NARRATIVE
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The investigation revealed the following:

Allegation: Staff spoke inappropriately to resident.

It is alleged that S2 (Staff #2) yelled at C1 (Client #1) in the Medication Room stating they do not want to talk to them while "drunk". LPA conducted interviews with 4 staff and 4 out of 4 staff denied the above allegation. S2 stated they do not recall the alleged incident and have never yelled at a client nor have they seen another staff yell at a client, S2 further stated that there is a glass that separates clients from staff at the medication room so they may speak a little more loudly to be heard but have never intentionally yelled or raised their voice at a client. Staff stated that they have never denied assisting clients while they are intoxicated and if anything they try to provide more assistance to the clients while intoxicated as they are on medications that may interfere with alcohol consumption. LPA interviewed 11 clients and 9 out of 11 clients stated that the staff treat them with dignity and respect and have never yelled at them nor refused to provide them assistance or care while intoxicated.

Based on statements and interviews conducted with staff and clients, there was not enough supportive evidence to concur with the reported allegation.

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 held, and a copy of this report was provided to Administrator Andrew DeVera.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC9099 (FAS) - (06/04)
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