198600539-2-22-2024-28-AS-RORN-D2WSSX-20240229130840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 02/22/2024
Date Signed: 02/22/2024 02:40:38 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
02/20/2024 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240220090011

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	SANTOS DOMINGUEZ		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 149	DATE:	02/22/2024
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Andrew De-Vera - Administrator		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff does not ensure facility is kept free of pests for clients in care.
Staff does not ensure facility is kept in clean, safe, sanitary conditions for clients in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met with Andrew De-Vera (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora obtained copies of the client and staff rosters, interviewed Administrator, Staff 1 - Staff 2 (S1 - S2), Client 1 - Client 11 (C1 - C11) and toured rooms 1, 5, 39, 41, 45, 109, 111, 112, 114, 212, 217. LPA reviewed pest control service reports dating back to 01/19/2024.

The investigation revealed the following: Regarding the allegation "staff does not ensure facility is kept free of pests for clients in care”, it is alleged that facility has bed bugs and roaches. Administrator and staff denied the allegation. They stated that pest control has been coming weekly. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

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-20240220090011

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: 02/22/2024

NARRATIVE

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Residents interviewed could not corroborate the allegation. Residents have not seen bed bugs or cockroaches in the facility or rooms. Residents also confirmed that pest control has been coming to fumigate their rooms. LPA Mora toured the following rooms: 1, 5, 39, 41, 45, 109, 111, 112, 114, 212, 217 and did not observed any bed bugs or cockroaches. LPA reviewed the pest control service reports and observed they came to the facility on 01/19/2024, 01/26/2024, 01/30/2024, 02/02/2024, 02/09/2024 and 02/16/2024.

Regarding the allegation "staff does not ensure facility is kept in clean, safe, sanitary conditions for clients in care”, it is alleged that client bedrooms are not being cleaned and there is mold in the bathrooms. Administrator and staff the denied the allegation. They stated that deep cleaning is done once a week or as needed and minor cleaning is done everyday. Residents interviewed could not corroborate the allegation. They stated that staff are cleaning their rooms and bathrooms, and some confirmed that deep cleaning is done once a week and minor cleaning is done daily. LPA Mora toured the following rooms: 1, 5, 39, 41, 45, 109, 111, 112, 114, 212, 217 and observed that rooms and the bathrooms are in adequate conditions.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024

LIC9099 (FAS) - (06/04)

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