198600539-4-23-2024-28-AS-TVAO-D4SVSK-20240429164137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 04/23/2024
Date Signed: 04/23/2024 03:14:18 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
08/30/2023 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230830101223

FACILITY NAME:	PICO RIVERA GARDENS		FACILITY NUMBER:	198600539
ADMINISTRATOR:	MEIR SHAUL YITZI TEICHMAN		FACILITY TYPE:	735
ADDRESS:	6525 ROSEMEAD BLVD.		TELEPHONE:	(562) 949-8489
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	185	CENSUS: 145	DATE:	04/23/2024
		UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Administrator Andrew DeVera		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff are having sexual interactions with clients.
Staff make inappropriate comments to the clients.
Staff enter the clients' rooms unannounced.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 04/23/2024 to deliver findings. Health and Safety check was conducted on 08/31/2023 by LPA Villalobos and LPA Vaid and needs further investigation was documented. Subsequent complaint visit was conducted by LPA Calderon on 01/12/24 and needs further investigation was documented. On 2/22/24, LPA Ramirez conducted subsequent complaint investigation and needs further was investigation was documented. LPA Ramirez was met by Administrator Andrew De-Vera and explained the purpose of the visit.
The investigation consisted of the following: LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), Resident Roster, Staff#1-3 interviews (S1-S3), Client interviews#1- 4 interviews (C1 – C4), Client#1- 5 (C1-C5): Emergency Contact Form, Physician Report, Appraisal/Needs and Services Plan, Investigations Branch-Investigation Assignment Report dated 4/4/24, other pertinent documents regarding this investigation and physical plant tour.
**SEE 9099-C for continuation**

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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-20230830101223

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: 04/23/2024

NARRATIVE

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The investigation revealed the following. Regarding Allegation(s): Staff are having sexual interactions with clients- It is alleged staff are engaging in sexual acts with clients in exchange for assistance with activities of daily living. Three (3) out of three (3) staff interviewed denied this allegation. One (1) out of four (4) clients interviewed denied this allegation. On 3/14/24, Investigator Edward Hector with Investigations Branch, conducted two (2) staff interviews and one (1) client interview. Two (2) out of the two (2) staff interviewed denied this allegation. One (1) out of one (1) client interviewed did not confirm this allegation. Although the allegation 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.

Staff make inappropriate comments to the clients- It is alleged staff are making inappropriate comments to clients while providing care. Three (3) out of three (3) staff interviewed denied this allegation. One (1) out of four (4) clients interviewed denied this allegation. On 3/14/24, Investigator Edward Hector with Investigations Branch, conducted two (2) staff interviews and one (1) client interview. Two (2) out of the two (2) staff interviewed denied this allegation. Declarations signed by Staff# 4 &5 (S4-S5) on 11/2/23, did not confirm this allegation. Although the allegation 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.

Staff enter the clients' rooms unannounced- It is alleged staff are entering clients’ rooms unannounced. Three (3) out of three (3) staff interviewed denied this allegation. One (1) out of four (4) clients interviewed denied this allegation. On 3/14/24, Investigator Edward Hector with Investigations Branch, conducted two (2) staff interviews and one (1) client interview. Two (2) out of the two (2) staff interviewed denied this allegation. Declarations signed by Staff# 4 &5 (S4-S5) on 11/2/23, did not confirm this allegation. Although the allegation 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.

Based on LPA’s interviews, interviews conducted by Investigator Hector, and records reviewed during this investigation, no deficiencies are being cited today. Exit interview conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC9099 (FAS) - (06/04)

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