198600539-5-28-2024-28-AS-FFIS-D6L34F-20240625175500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 05/28/2024
Date Signed: 05/28/2024 03:37:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
08/23/2023 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230823113613

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: 137	DATE:	05/28/2024
		UNANNOUNCED	TIME BEGAN:	03:26 PM
MET WITH:	Administrator, Tony Olmos		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Staff are not criminally record cleared

INVESTIGATION FINDINGS:

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***This report supersedes the previous complaint report conducted earlier on this date 5/28/24. The reason it’s being superseded is to correct findings delivered on 9099 from substantiated to unsubstantiated. No changes to the details on the report***

Licensing Program Analyst(s) (LPA) Sanjay Vaid and Jose Villalobos conducted a subsequent complaint visit for the allegation above. LPA's met with administrator Tony Olmos and the purpose of the visit was discussed.

On 08/25/2023 LPA Villalobos interviewed two (2) staff and one(1) client, collected and reviewed documents of staff and client files. As of now, LPAs have collected copies of the staff and client roster, a total of (26) staff files to review criminal record clearances and first aid/CPR documentation, interviewed staff #1-#5 (S1-S5) and client #1 (C1). The investigation revealed the following:

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

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-20230823113613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 05/28/2024

NARRATIVE

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***This report supersedes the previous complaint report conducted earlier on this date 5/28/24. The reason it’s being superseded is to correct findings from delivered on 9099 from substantiated to unsubstantiated. No changes to the details on the report***

Regarding the allegation: "Staff are not criminally record cleared." It is alleged that staff are working in the facility without background clearance. (5) of (5) Staff interviewed denied the allegation. (1) of (1) Client interviewed could not corroborate the allegation. On 04/09/24, LPA's Vaid and Reyes took copies of the Staff/Resident rosters, interviewed S#1 and reviewed files for Staff #2-Staff#3 (S2-S3) . LPA's did not observe S#2 and S#3 criminally cleared and associated to work in the facility. S#4 checked with the Care Provider Management Bureau regarding staff S#2 and S#3 for Criminal Background Clearance. Per S#4, both staff were cleared, however, a error was made during the live scan process, therefore the both staff did not get associated to the facility. S2 and S3 have been criminally record cleared since 12/13/23 as noted on their DOJ Response letter. While conducting further file reviews, LPAs reviewed a total of twenty six (26) Staff files and observed all staff to be criminally record cleared and associated. Staff currently on roster are all cleared.

Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

LIC9099 (FAS) - (06/04)

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