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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 03/29/2024
Date Signed: 03/29/2024 12:28:40 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
03/12/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240312094235
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: 143DATE:
03/29/2024
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Faviola Padilla - Med TechTIME COMPLETED:
12:43 PM
ALLEGATION(S):
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Staff are not providing a comfortable environment for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit to address the allegation 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 are not providing a comfortable environment for residents," it is alleged that C14, C15, C16, and C17 use use vulgar language, cursing, profanity, and racial slurs towards other clients and that staff are doing nothing about it.
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 2
Control Number 28-AS-20240312094235
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, twelve (12) out of seventeen (17) did not corroborate the allegation that the staff are not providing a comfortable environment in the facility by allowing some clients to verbally harass others. One of the clients who corroborated the allegation stated that C14 does scare them by threatening them with physical violence and calling them names in the facility, and that they have reported these issues to staff however they do not seem to be doing anything about it. Another client similarly reported that C14 has been stalking and harassing them for years, and recently threw a lighter at them in a hallway. During interviews with the staff, none of them corroborated the allegation. One of the staff interviewed stated that the identified individuals are most often having conversations with themselves when they are cursing and using vulgar language, and that it is not directed at any of the other clients. Another staff interviewed stated that if verbal harassment does occur amongst the clients, they will work to intervene and redirect the client causing the harassment until they calm down. On 3/25/2024, LPA received a 30-day eviction notice for C14 due to their repeated violations of the house rules related to verbally abusing staff and clients, going into other clients rooms and stealing their possessions, smoking in the facility, and destruction of property.

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)
Page: 2 of 2