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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600539
Report Date: 02/16/2024
Date Signed: 02/16/2024 11:25:53 AM

Document Has Been Signed on 02/16/2024 11:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 GARDENSFACILITY NUMBER:
198600539
ADMINISTRATOR:SANTOS DOMINGUEZFACILITY TYPE:
735
ADDRESS:6525 ROSEMEAD BLVD.TELEPHONE:
(562) 949-8489
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 185CENSUS: 146DATE:
02/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Andrew De Vera, Assistant Administrator TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Galarza conducted a Case Management- Incident visit to follow up on an incident report submitted to the Regional Office on 2/15/2024. LPA met with Assistant Administrator Andrew De Vera. The purpose of today's visit is to check on the health & safety of residents in care.

On February 12, 2024 at 5:10 AM, resident (R1) lit on fire the hallway surveillance camera located near an exit door close to room 12. The smoke alarms were activated and staff responded immediately and extinguished the small fire. The local Fire Department, Station 13 was notified and an inspection is pending.

During today's visit the following was conducted:


  • A physical plant tour of the facility focusing on surveillance cameras was conducted. The affected camera is still operable. The only damage to the camera was the exterior face cover that melted.
  • No damage to walls and building was observed.


No health and safety issues were observed.

An exit interview was with Julia Elias. A copy of the report and appeal rights were issued.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR 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.

LIC809 (FAS) - (06/04)
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