198600539-5-24-2024-28-AS-RORN-D5XT2H-20240605142047

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 05/24/2024
Date Signed: 05/24/2024 01:09:49 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
05/07/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240507082926

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: 136	DATE:	05/24/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Tony Olmos - Administrator		TIME COMPLETED:	01:23 PM

ALLEGATION(S):

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Clients not accorded dignity in relationships with staff
Staff served contaminated beverages to clients in care
Staff does not ensure client is spoken to in an appropriate manner
Staff did not ensure clients personal property was secured
Staff did not prevent resident from engaging in inappropriate behaviors
Staff did not prevent resident from making inappropriate comments towards another resident
Staff are not meeting resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analsyts (LPAs) Erik Zaragoza and Daniel Konishi conducted a subsequent unannounced complaint visit in regards to the allegations listed above. LPAs explained the purpose of the visit to Tony Olmos, Administrator for the facility, and was granted entrance.

The investigation consisted of the following: During the initial visit conducted on 5/10/2024, LPAs Erik Zaragoza and Daniel Konishi obtained staff and client rosters, obtained meal menu, toured the kitchen and food supply, obtained the Physician's Report, Appraisal, and FACE Sheet from Clients #1 and #2 (C1 - C2). LPAs also interviewed Clients #3 - 6 (C3 - C6), and also Staff #1 - 4 (S1 - S4). LPAs also conducted a tour of facility. Since the initial visit, LPAs interviewed C2, Clients #7 - 14 (C7 - C14), and also interviewed Staff #5 (S5). During today's visit, LPAs interviewed C1 and delivered findings.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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 5

Control Number 28-AS-20240507082926

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: 05/24/2024

NARRATIVE

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In regards to the allegation that "Clients not accorded dignity in relationships with staff," it is alleged that S4 deliberately turns up the volume of the facility's intercom system and shouts into it when addressing the clients. During interviews with the clients, ten (10) out of fourteen (14) clients interviewed did not corroborate the allegation that staff have been shouting at clients over the intercom system. One client interviewed believes that they facility staff should turn up the volume of the intercom system a little bit rather than lower it. Another client interviewed stated that the intercom system's volume is adequate and does not need to be adjusted. During interviews with the staff, none of them corroborated that they should at residents through the intercom system. During an interview with S4, they stated that they do not touch or adjust the volume of the intercom system, and that they do not shout at residents through the intercom. During interview with S3, they stated that they are in control of the intercom system's volume, and they stated that it is always set at a certain volume and that they never change it.

In regards to the allegation that "Staff served contaminated beverages to clients in care," it is alleged that C1 was served a glass of milk that had a hair in it. During interviews with the clients, thirteen (13) out of sixteen (16) did not corroborate the allegation that they have been served contaminated beverages in the past. One of the clients interviewed explained that they have never had any issues with the beverages that have been served by the kitchen staff, and that they have never found any contaminants in their beverages. Another client interviewed stated that "everything is fine" with the beverages that are served by the kitchen staff. During interviews with the facility staff, none of them corroborated the allegation that any contaminated beverages have been served to the clients. LPAs interviewed S5, the cooking supervisor for the facility, and they stated that the kitchen staff make sure to wear hair mats when cooking, and wear gloves when handling and serving food to the clients to ensure that no beverages get contaminated with hair or any other substances. S5 stated that they have never seen any client's beverage become contaminated with a hair, however if it were they would serve the client a new beverage. During a tour of the facility's kitchen, LPAs found a sufficient supply of milk and juice in the facility, and the juices served to clients did not appear to be contaminated with hair or any other substances.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 28-AS-20240507082926

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: 05/24/2024

NARRATIVE

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In regards to the allegation that "Staff does not ensure client is spoken to in an appropriate manner," it was alleged that S3 cursed at C1 in one of the hallways of the facility. During interviews with the clients, eleven (11) out of fourteen (14) clients did not corroborate the allegation. One of the clients interviewed stated that they have never seen S3 or any of the other staff cursing at any of the clients within the facility. Another client stated that they have never seen S3 be mean to other clients in the facility and believes that S3 is very nice to other clients. During interviews with the staff, none of them corroborated the allegation that other staff have spoken inappropriately to the clients. During an interview with S3, they stated that they never cursed at C1. S3 stated that they do not speak inappropriately to any client in the facility, and it is rather C1 who has yelled at S3 in the past. None of the other staff stated that they have seen S3 speak inappropriately to C1 or other clients in the past.

In regards to the allegation that "Staff did not ensure clients personal property was secured," it was alleged that C1 had headphone and two (2) caps that were stolen from their room. During interviews with the clients, eleven (11) out of fourteen (14) clients did not corroborate that their personal belongings were not safeguarded by the facility staff. One of the clients interviewed stated that they have never had a problem with their belongings getting stolen while living at the facility. During with an interview with C1's roommate, they stated that they have never stolen any of C1's personal belongings. During staff interviews, none of them corroborated that they do not safeguard the client's personal belongings if they ask for them to be safeguarded. One of the staff members interviewed stated that, C1 has all of their possessions currently and was seen recently walking around the facility with the same headphones and hat that they always wear. Another staff member interviewed stated that C1 found their caps and headphones after initially reporting them lost. During a record review of C1's inventory list, it stated that C1 had no personal property to declare for safeguarding.

In regards to the allegation that "Staff did not prevent resident from engaging in inappropriate behaviors," it is alleged that staff are not preventing C1's roommate, C2, from bringing over visitors into their room at midnight which is past the facility's visitation hours. During interviews with the clients, eleven (11) out of fourteen (14) did not corroborate that staff are not preventing clients from bringing over visitors during the midnight hours. One client stated that the facility's night visitation hours are between 7 PM - 9 PM, and that there have not been any problems with outside visitors coming into the facility after 9 PM.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20240507082926

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: 05/24/2024

NARRATIVE

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During an interview with C2, they stated that they have never brought over any visitors into the facility, and that the allegation is not true. During interviews with the staff, none of them corroborated the allegation that they allow outside visitors to come into the facility after visitation hours have ended. One of the staff interviewed stated that C1 never reported any visitors going into their room late at night to staff, and therefore was unaware of this occurring. Another staff interviewed stated that C1 brought up a hypothetical situation involving their roommate bringing over late night visitors, however they never stated that this actually occurred.

In regards to the allegation that "Staff did not prevent resident from making inappropriate comments towards another resident," it is alleged that C2 has bullied C1, and C2 told C1 that they are going to intentionally spread HIV to C1, and staff have done nothing in response to this. During interviews with the clients, thirteen (13) out of fourteen (14) did not corroborate the allegation that staff do not prevent clients from making inappropriate comments toward other clients. During an interview with C2, they stated that they have never bullied C1 and instead stated that C1 has been mean to them in the past. Interviews with other clients revealed that sometimes clients do yell at each other, however staff intervene in order to de-escalate these situations. During interviews with the staff, none of them corroborated the allegation. One staff stated that they were never made aware that C2 was bullying C1, however they would speak with the parties if this would be reported. Another staff interviewed stated that C2 never bullied C1 while they were roommates, however they would if intervene if necessary.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20240507082926

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: 05/24/2024

NARRATIVE

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In regards to the allegation that "Staff are not meeting resident's needs," it is alleged that C1 requested a new roommate from C2, however their request was being denied by the staff. During interviews with the client, thirteen (13) out of fourteen (14) did not corroborate the allegation. All clients interviewed indicated that their needs are being met by the facility staff and have not had any of their requests get refused or ignored by staff. During interviews with the staff, none of them corroborated the allegation that they are not meeting the needs of C1 or any other client. One staff indicated that they had already found a new roommate for C1 and moved C2 to a new room, and LPAs confirmed that this is the case. Another staff interviewed stated that C1 often has issues with their roommates and frequently asks for new roommates.

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: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC9099 (FAS) - (06/04)

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