198600539-4-16-2024-28-AS-WSHO-D4GSR6-20240419140547

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 04/16/2024
Date Signed: 04/16/2024 01:32:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/15/2024 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240415090202

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: 145	DATE:	04/16/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	AdministratorTony Olmos		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not ensure client was spoken to in an appropriate manner
Staff physically handled client in an inappropriate manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced complaint investigation visit for the allegations above. LPA met with Administrator Tony Olmos and the purpose of the visit was discussed.
On todays visit Interview was conducted with the Administrator at 9:55 AM.
LPA interviewed Staff S1-S2 (S1-S2) and Clients C1- C8 (C1-C8) from 10AM to 12:00 PM.
LPA also collected and reviewed the following documents: staff and client roster, C1's physicians report, C1's Face sheet, C1's admissions agreement.
LPA at 9:40 AM viewed facility video footage from 04/15/2024. Video was viewed that day from 8:37:18 to 912:58.
The investigation revealed the following:
In regards to Staff did not ensure client was spoken to in an appropriate manner, based on interviews conducted and information gathered 7 of 8 clients stated that staff have not been verbally abusive to the clients.
7 of 8 clients stated that staff are professional and nice and help assist them with medication, food and

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240415090202

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 04/16/2024

NARRATIVE

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other things they may need.
4 of 7 clients who know C1 have not heard of or observed of staff using inappropriate language toward C1.
Also stated they are nice to C1 who often gets upset over many things and can be loud and staff calm him down.
Interview with Staff S 1 who stated that C 1 kept knocking on the door and staff told him they were in a meeting.
Said she looked at video and don't know where the complaints came from because there was no wrongdoing.
Stated there have been many complaints made by C 1 to licensing and that they don't yell at any client.
Interview with S 2 who stated that he did not hear any loud voices when the Administrator went out to talk with C1. Stated C1 can be boisterous and loud. Said that the Administrator is very calm.
Interview with Administrator who stated that he had asked C1 to please be patient we are in a meeting. Said he never hit or yelled at C 1.
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.

In regards to the allegation Staff physically handled client in an inappropriate manner, based on interviews conducted and video footage it was revealed on the video footage observed by LPA that the Administrator never touched C1. Video shows the interaction with the Administrator and C1 lasted from 8:37:17 to 8:37:48
and then the Administrator went back to the office while C1 was observed in the main lobby area on his phone. LPA viewed C1 leaving and walking toward the client rooms at 9:12:58 AM.
The Administrator and C1 interacted for 31 seconds on the video and the Administrator was not seen interacting with C1 after that. LPA observed that the Administrator did not put his hands on C1 and acted appropriately.
Interview with C1 who stated that the new staff put hands on him so lightly. Stated he was barely being touched so he is not bringing charges.
Interview with 7 of 8 clients who stated that staff are not physically abusive toward clients.
Interview with Staff who stated that the video footage shows that C1 was not handled in an inappropriate manner. Stated that staff never physically or verbally abusive to C1 and that many times he has complained to Licensing on many things that are happening to him, but are always Unsubstantiated.
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.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024

LIC9099 (FAS) - (06/04)

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