198600539-5-14-2024-28-AS-RORN-D5SMR7-20240531094953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 05/14/2024
Date Signed: 05/14/2024 04:13:08 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
05/03/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240503094719

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: 135	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Mary Marquez - Med Tech		TIME COMPLETED:	04:13 PM

ALLEGATION(S):

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Staff did not ensure resident's toilet was not in disrepair
Staff did not ensure resident's medication was not contaminated
Staff are not providing adequate food service to resident
Staff do not treat resident with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Erik Zaragoza and Daniel Konishi conducted a subsequent complaint visit to investigate the above allegations. LPAs met with Mary Marquez, Med Tech for the facility, and explained the purpose of the visit. LPAs were met by Tony Olmos, facility administrator, shortly thereafter.

The investigation consisted of the following: During the initial visit conducted on 5/10/2024, LPAs obtained staff and client rosters, obtained meal menu, toured the kitchen and food supply, reviewed medications for 5 random clients, obtained the Physician's Report, Appraisal, and FACE Sheet from Client #1 (C1). LPAs also interviewed Clients #2 - 5 (C2 - C5), and also Staff #1 - 4 (S1 - S4). LPAs also conducted a tour of facility. LPAs attempted to interview C1, however they are currently hospitalized and could not be interviewed. During today's visit, LPAs interviewed Clients #6 - 14 (C6 - C14), and Staff #5 (S5). LPAs attempted to interview C1, however they are still currently hospitalized as of 5/14/2024, and all phone calls made to C1's cell phone went straight to voicemail.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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-20240503094719

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: 05/14/2024

NARRATIVE

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The investigation revealed the following: In regards to the allegation "Staff did not ensure resident's toilet was not in disrepair," it is alleged that C1 reported that their toilet had been clogged on the night of 5/2/2024 and had not been fixed until 5/3/2024. During interviews with the clients, eleven (11) out of fourteen (14) clients interviewed stated that they do not have any issues with the maintenance of their toilets. One client interviewed stated that they have had their toilet clogged in the past, however the maintenance team has always fixed the issue in a timely manner. Other clients indicated that they have never had any issues with their toilets overflowing with water or being clogged. During interviews with the staff, none of them corroborated that they do not ensure that client's toilets are not in disrepair. During an interview with a maintenance staff lead, they stated that they did fix C1's toilet. The maintenance staff indicated that they were notified that C1's toilet had been overflowed on late 5/2/2024, and that they fixed it in the morning of 5/3/2024 which is around the average time that they fix toilet issues. LPAs reviewed the maintenance logs and confirmed that C1 reported the issue to staff on 5/2/2024 and was fixed on 5/3/2024.

In regards to the allegation "Staff did not ensure resident's medication was not contaminated," it is alleged that C1 found rocks in their medication believe it was placed there by staff. During interviews with the clients, thirteen (13) out of fourteen (14) did not corroborate the allegation that their medications have been contaminated. All clients interviewed at the facility stated that they do not have any issues with obtaining their medications, and none of them stated that they have ever seen any debris or rocks in their medication cups. During interviews with the staff, none of them corroborated that they allow the clients' medications to become contaminated. One Med Tech explained that they dispense medications directly into a cup to ensure that no outside substances come into contact with the medications. Another staff interviewed stated that the Med Techs make sure to check C1's medications before they dispense it to C1, and they also show it to C1 before dispensing the cup to C1.

In regards to the allegation "Staff are not providing adequate food service to resident," it is alleged that C1 found a piece of metal in one of their sandwiches, and that their coffee smelled like perfume was added to it. During interviews with the clients, eleven (11) out of fourteen (14) did not corroborate that the facility's food service is inadequate. One client interviewed stated that they are satisfied with the food that is served at the facility, and that they have no concerns with it being contaminated with any foreign substances. Another client interviewed stated that the facility offers an alternative menu for the clients, so if they are not satisfied with anything on the main menu, they can always ask for an alternative.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240503094719

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: 05/14/2024

NARRATIVE

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During interviews with the staff, none of the staff interviewed corroborated the allegation. One of the staff who is a cooking supervisor for the facility stated that they use hair mats, gloves, and wash then hands when handling and preparing food to ensure that it does not become contaminated with food, and they also serve the food in front of clients to show that it is not contaminated. The kitchen supervisor also stated that if a meal were ever to become contaminated, they would throw a contaminated plate away and replace the plate with another one.

In regards to the allegation "Staff do not treat residents with dignity and respect," it was alleged that S1 and S2 do not treat C1's concerns seriously and do not believe what C1 says. During interviews with the clients, twelve (12) out of fourteen (14) clients interviewed could not corroborate the allegation that staff do not treat residents with dignity and respect. One client interviewed stated that S1 and S2 are very nice and that they treat all of the clients with dignity and respect. Another client interviewed stated that S1 and S2 does a good job and that all staff members in the facility treat others with dignity and respect. During interviews with the staff, none of them corroborated that they do not treat the clients with dignity and respect. S2 explained that it is not true that they do not treat C1 without dignity and respect, and that sometimes C1 will ask to speak with them when they are in a meeting or are busy so they tell C1 they will speak with them afterwards, and that C1 interprets the staff as being rude. S1 stated that all staff in the facility make sure to treat all clients with dignity and respect.

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: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

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