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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/05/2024
Date Signed: 03/05/2024 12:25:49 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
06/06/2022 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220606161345
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: DATE:
03/05/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Andrew De-Vera - AdministratorTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff inappropriately touched resident.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Tena Herrera and Daniel Konishi conducted an unannounced complaint visit regarding the above allegation. LPA met with Andrew De-Vera (Administrator) and explained the reason for the visit.

The investigation consisted of the following:

LPAs obtained copies of Staff and Client Rosters, there were 6 Staff interviews and 10 Client interviews conducted through out the facility during visit.

(Continued on the LIC9099-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: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
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-20220606161345
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: 03/05/2024
NARRATIVE
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The investigation revealed the following:

Allegation: Staff inappropriately touched resident.

It is alleged that staff inappropriately touched C1 in their private area. LPA interviewed C1 and C1 stated that this never happened and they have never been inappropriately touched by any staff and feel that staff (to the best of their ability) provide a safe environment for clients in care. This complaint was also investigated by the Investigations Branch in which C1 "denied they were inappropriately touched by staff members or any residents at the facility". LPAs interviewed 6 Staff and 6 out of 6 staff stated that they have never touched a client inappropriately and have never heard of another staff doing so. LPAs interviewed 10 Clients and 9 out of 10 Clients stated that they have never been inappropriately touched by staff or other clients at the facility and feel that the staff treat them well.

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

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 Andrew De-Vera.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2