198600539-4-30-2024-28-AS-DSIS-D52SDW-20240507134748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 04/30/2024
Date Signed: 04/30/2024 12:22:05 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
04/23/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240423152051

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: 140	DATE:	04/30/2024
		UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Tony Olmos - Administrator		TIME COMPLETED:	12:36 PM

ALLEGATION(S):

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Staff did not safeguard resident’s belongings

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Erik Zaragoza and Daniel Konishi conducted an initial unannounced complaint visit to address the allegation listed above. LPAs met with Tony Olmos, Administrator for the facility, and was allowed entrance.

The investigation consisted of the following: LPAs obtained a copy of a staff and client roster, interviewed Clients #1 - 15 (C1 - C15), and Staff #1 - 4 (S1 - S4), toured storage room B of the facility, and also obtained the inventory list and an Identification and Emergency Information sheet for C1.

The investigation revealed the following: In regards to the allegation that "Staff does not safeguard resident's belongings," it is alleged that after C1 had left the facility, their belongings were packed by a family member and given to the administrator of the facility, and when C1 attempted to contact the administrator in order to pick up her belongings, she was told that the facility no longer had them.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

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-20240423152051

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: 04/30/2024

NARRATIVE

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During interviews with the staff, none of them corroborated the allegation that they did not safeguard C1's personal belongings. One of the staff interviewed stated that after C1 left the facility, they never returned to pick up their belongings, and that they were still in the storage room of the facility. Another staff interviewed explained that once residents move out of the facility and leave their personal belongings behind, the maintenance department is responsible for holding the items in the storage room. LPAs toured storage room B of the facility with the maintenance department and administrator Tony Olmos and observed C1's belongings in multiple bags and suitcases, along with their microwave. During interviews with the clients, fourteen (14) out of fifteen (15) did not corroborate the allegation that staff have not been safeguarding their personal belongings. One client interviewed stated that they have had clothing go missing from their room in the past, however staff assisted in replacing them. Other residents interviewed did not indicate that they had any issues with their personal belongings going missing while living in the facility. S2 stated that C1 can call them so that they can arrange to have C1's belongings picked up from the facility.

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: 04/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

LIC9099 (FAS) - (06/04)

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