198600539-3-29-2024-28-AS-DSIS-D46PBL-20240409111027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/29/2024
Date Signed: 03/29/2024 12:26:19 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
03/11/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240311115926

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: 143	DATE:	03/29/2024
		UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Faviola Padilla - Med Tech		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff yelled at resident.
Facility has bed bugs.
Facility's intercom system is too loud causing discomfort to resident.
Facility staff allow residents to smoke marijuana inside the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit to address the allegations listed above. LPA was met with Faviola Padilla, Med Tech for the facility, and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 3/18/2024, LPA Erik Zaragoza obtained a copy of a staff and client roster, reviewed the medications for five (5) randomly selected clients along with their Medication Administration Records (MARs), interviewed Clients #1 - 17 (C1 - C17), and Staff #1 - 3 (S1 - S3), and toured nine (9) client bedrooms. During today's visit LPA interviewed Staff #4 (S4) and delivered findings.

The investigaiton revealed the following: In regards to the allegation that the "Staff yelled at resident," it is alleged that S3 yelled at C1 because C1 brought up their concerns about their medications being potentially contaminated.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

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 3

Control Number 28-AS-20240311115926

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: 03/29/2024

NARRATIVE

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During interviews with the clients, thirteen (13) out of seventeen (17) interviewed did not corroborate the allegation that they have been yelled at by staff in the past. Some clients interviewed indicated that staff have given them attitude when speaking to them or raised their voice at them in the past, however most clients stated that they have never been yelled at before and have never had any issues with the staff in the facility. During interviews with the staff, none of them corroborated the allegation that staff have yelled at clients in the facility before. S3 stated that C1 has made several allegations that they have raised their voice against C1 in the past, however this is not true and S3 stated they have never yelled at any of the clients in the facility. All other staff stated that they have never seen S3 nor any other staff yelling at clients in the facility.

In regards to the allegation that "Facility has bed bugs," it is alleged that the facility has had an issue with bed bugs being present in the client bedrooms. During interviews with the clients, fourteen (14) out of seventeen (17) interviewed did not corroborate the allegation that the facility has an issue with bed bugs. One of the clients interviewed stated that while the facility has had bedbugs infest some rooms in the facility in the past, the facility works with a pest control company that sprays affected rooms in order to address the issue. Another client stated that some of the clients have issues with hygiene and bring bedbugs into the facility which causes them to reappear in rooms, leading to the need for additional services from pest control, however the facility has been adequate in addressing issues with bedbugs when they arise. During interviews with staff, none of them corroborate the allegation that the facility currently has an issue with bedbugs. One of the staff interviewed stated that whenever they receive a complaint from a client that their room has an issue with bedbugs, they make sure to identify the rooms of concern and contact their pest control company to service the affect rooms. LPA reviewed the service log from the pest control company and observed that they had most recently serviced the facility on the dates 3/15/2024, 2/29/2024, and 2/23/2024 during which they serviced different units and areas of the facility. LPA toured nine (9) of the client bedrooms and checked for bedbugs around the headboard and mattresses of the clients beds, however LPA did not observe any bedbugs present within any of the rooms.

In regards to the allegation that the "Facility's intercom system is too loud," it is alleged that the intercom system's speaker is too loud and that it hurts the ears of the clients in the facility. During interviews with the clients, sixteen (16) out of seventeen (17) did not corroborate that the facility's intercom system is too loud. Nearly all of the clients interviewed stated that they have no issues with the volume of the facility's intercom system.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20240311115926

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: 03/29/2024

NARRATIVE

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During interviews with the staff, none of them corroborated the allegation that the facility's intercom system is too loud. One of the staff interviewed stated that they have received multiple complaints regarding the facility's intercom system being too loud, and that they have already turned the volume down as much as possible to avoid it potentially hurting the other clients in the facility, however they cannot turn the volume down any lower otherwise the other clients in the facility may not be able to hear it.

In regards to the allegation that "Facility staff allow residents to smoke marijuana in the facility," it is alleged that clients smoke marijuana on the balconies of their rooms as well as within the facility's hallways without repercussions from staff. During interviews with the clients, fifteen (15) out of seventeen (17) did not corroborate the allegation that staff allow clients to smoke marijuana within the facility. One of the clients interviewed stated that staff do not allow them to smoke marijuana within the facility, and if someone is caught smoking marijuana they are verbally warned against smoking in the facility, and if the issue persists they will be issued an eviction notice. During interviews with the staff, none of them corroborated the allegation that they allow clients to smoke marijuana within the facility. One of the staff interviewed stated that smoking marijuana in the facility is against the house rules, and if a client is caught smoking marijuana they will be given a verbal warning, then a written warning, and lastly an eviction notice if they are caught smoking in the facility a third time.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, 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 was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2024

LIC9099 (FAS) - (06/04)

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