198600539-3-25-2024-28-AS-LHIS-D4FQPQ-20240418122103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/25/2024
Date Signed: 03/25/2024 04:22:01 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
03/21/2024 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240321160308

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: 142	DATE:	03/25/2024
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:			TIME COMPLETED:	04:37 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not properly cleaning clients room.
Facility staff do not treat clients with dignity or respect.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst(LPA) Alberto Lopez conducted an initial unannounced complaint visit to address the allegations listed above. LPA met with Andrew De Vera, Administrator for the facility, and was granted access into the facility.

The investigation consisted of the following: LPA obtained a copy of a staff and client roster, interviewed Clients #1 - 15 (C1 – C15), and Staff #1 - 6 (S1 – S6), toured ten(10) bedrooms. and common areas
The investigation revealed the following: Regarding the allegation that Facility staff are not properly cleaning clients room. It is alleged that housekeeping staff are not cleaning the clients rooms. LPA interviewed six staff and 6 of 6 staff denied the allegation. S4 and S5 stated that at times the clients refuse to leave the rooms and staff are unable to have full access to the rooms and move on to the next rooms. If time permits, they will return to the room to clean it but if denied access, they will not be able to clean the room that day. LPA observed room in question to be clean, with clean towels and 2 rolls of toilet paper and everything operational. LPA interviewed 15 clients and 13 of 15 clients stated that staff clean their rooms, including bathroom weekly and their sheets are also changed weekly.
(Continued on 809C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

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-20240321160308

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: 03/25/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA observed the 10 rooms randomly selected to be clean and housekeepers cleaning rooms during today’s visit. There is insufficient evidence to substantiate this allegation.

The investigation revealed the following: Regarding the allegation that Facility staff do not treat clients with dignity or respect. It is alleged that staff are yelling and dis-respecting clients in care. LPA interviewed 15 residents and 12 of 15 clients could not collaborate the allegations. LPA interviewed 6 staff and all six staff denied the allegations. LPA did not observed any staff yelling or being disrespectful to clients during the day long visit today. There is insufficient evidence to substantiate this allegation.

Based on statements and interviews conducted with staff, clients, and LPA observation of random rooms, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report and appeal rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2