198600539-2-16-2024-28-AS-LHIS-D2Q28W-20240222161059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/16/2024
Date Signed: 02/16/2024 11:05:38 AM

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
02/12/2024 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240212121711

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 146	DATE:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	08:52 AM
MET WITH:	Andrew De Vera, Assistant Administrator		TIME COMPLETED:	10:52 AM

ALLEGATION(S):

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Facilities intercom system is too loud causing discomfort to clients.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegations. The purpose of the visit was discussed with Assistant Administrator Andrew De Vera whom assisted with the physical plant inspection.

The investigation consisted of: A physical tour of the facility with a focus on intercom speakers and R1’s was conducted. The intercom sound system was tested for loudness close to R1’s room. Staff (S1- S5) and residents (R1-R16) were interviewed. Resident (R1's) file documents [Identification and Emergency Information, Preplacement Appraisal, Physician Report, Psychiatric Notes, Appraisal Needs/Services Plan, LIC 500 Personnel Report, and client rosters were obtained.

***Narrative continues next page. ****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240212121711

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: 02/16/2024

NARRATIVE

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Allegation: Facilities intercom system is too loud causing discomfort to clients. It is alleged that the intercom speaker’s volume is too loud and when staff speak on the intercom they scream, which is causing resident(s) to be in pain and making their ears hurt. It was reported that on Saturday 2/10/2024, staff (S6) turned up the volume in the intercom system, and as a result caused resident (R1) to lose control and break furniture. Based on file review, resident (R1) is a resident with a mental health condition that includes auditory problems. A total of 16 residents were interviewed, of which two (2) residents stated that the intercom speakers are too loud all day long. All staff interviewed denied the allegation and stated that R1 has known history of auditory sensitivity problems. Staff stated that the intercom system volume ranges between 1-10, and it is presently at level 2 in order to accommodate R1's needs. However, the speakers volume cannot be lowered any further, because it can pose a health and safety hazard to residents in case of an emergency. LPA checked the intercom system speakers in all areas of the building, including the area closest to R1's room and determined the sound volume is within a reasonable volume level. The facility has intercom speakers in common areas and building hallways. Per record review of Physician records, the findings indicate that R1 has bilateral tubes in ears and impaired insight and judgement, which is likely causing auditory processing issues. It was recommended that the facility obtain a specialist referral to an ENT Physician for an evaluation. There is insufficient evidence to corroborate the 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.

An exit interview was conducted with Andrew DeVera. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/16/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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