198600539-5-30-2024-28-AS-RORN-D5WVNZ-20240604163559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600539
Report Date: 05/30/2024
Date Signed: 05/30/2024 03:50:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/04/2023 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230404090135

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:	05/30/2024
		UNANNOUNCED	TIME BEGAN:	10:31 AM
MET WITH:	Administrator Tony Olmos		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Residents sustained multiple wounds due to neglect.
Resident sustained multiple falls due to lack of supervision.
Facility staff do not ensure resident eats meals regularly.
Facility staff have not attended to a roach infestation in a resident's room.
Facility staff do not ensure that residents' hygiene needs are met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegations listed above. LPA met with administrator Tony Olmos and the purpose of the visit was discussed.

Initial visit conducted by LPA Calderon on 4/5/2023 consisted of the following: LPA obtained a copy of the staff and client roster, Clients #1-5 Physican Reports and Appraisel/Needs and Service Plan. LPA toured the physical plant including, but not limited to the following: the interior of the facility. Two story building sides A and B, cafeteria/dining area, Telecare Activity Center , TV Room (unavailable due to repairs), Room numbers: 8,17 (vacant for repairs),33,48, 101,108, 218,and 220. As of todays visit, LPA Villalobos has conducted the following: LPA interiewed Staff #1-#6 (S1-S6) and Clients #1-#4 (C1-C4) then #6-14 (C6-C14). C5 is no longer available for interview. LPA toured the physical plant common rooms previously done by LPA Calderon as well as rooms #48, #46 , #49 and #50. LPA collected and reviewed incident reports regarding C1-C4 for the months of January 2023-April 2023 and any pest control documents from the same time period. 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: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

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-20230404090135

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 05/30/2024

NARRATIVE

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In regards to the allegation "Residents sustained multiple wounds due to neglect" it is alleged that
C2 and C4 have multiple scabs and wounds throughout their bodies. (6) of (6) Staff interviewed denied the allegation. (12) of (13) Clients interviewed could not corroborate the allegation. Details provided to LPA stated that C2 scabs and scars completely covering their bodies. When LPA attempted to interview C2, C2 refused to answer LPA's questions. LPA did not observe scab wounds covering the visible body parts of C2. Details provided regarding C4 state that had a large infected scab on their head. LPA observed C4 to have a scab on the top of their head. C4 explained to LPA that they had cut their skin accidentally when shaving their head. C4 did not notify staff of the wound as it was healing on its own and do not want assistance. C4 stated that they had been shaving their head on their own for years. C4 stated they have no other wounds on their body. Interviews with staff confirmed the same information. File review shows that C4 is able to care for their own grooming needs. File review does not show any documentation of either C2 or C4 sustaining multiple wounds around their bodies. Based on interviews, file review, and observations conducted although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Resident sustained multiple falls due to lack of supervision" is is alleged that C1 had a stroke that had not fully healed causing them to fall often when staff supervision was required. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. C1 denied having a stroke ever in their life and that they constant staff supervision. C1 denied having falls in the facility. Staff interviewed stated that C1 has not had a stroke and has not had any falls in the facility. File review does not show that C1 has had a stroke or any falls in the facility. LPA observed C1 to be ambulatory and walking throughout the facility on their own. Based on interviews, file review, and observations conducted although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Facility staff do not ensure resident eats meals regularly" it alleged that staff are not ensuring that C3 is eating meals in the facility. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. Interview with C3 stated that they do eat regularly in the facility but there are times when they prefer not to eat at certain times. Staff interviewed stated they are not aware of any problem regarding C3 not eating in the facility. Interviews shows that it is C3's personal choice to not eat and they cannot be forced to eat meals..... Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230404090135

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PICO RIVERA GARDENS	FACILITY NUMBER: 198600539
	VISIT DATE: 05/30/2024

NARRATIVE

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LPA observed C3 to be thin but C3 stated they had always been. File review does not show that there is a special diet in place for C3 or a care plan for ensuring C3 eats all 3 meals a day. File review shows C3 is able to feed themselves and there is no special diet to follow. Based on interviews, file review, and observations conducted although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Facility staff have not attended to a roach infestation in a resident's room" it is alleged that C3 has a roach infestation in their room. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. Interviews state that the facility will always address any pests issues when they are informed about them. C3 denied roach infestation in their room. Staff interviewed denied any knowledge of there being a roach infestation in C3's room. There are no observations of roaches in LPA Calderon's tour of the physical plant during the initial visit. LPA Villalobos did not observe any roaches in C3's room during todays visit either. LPA Villalobos reviewed pest control notes from January-March 2023 and it is noted that roach gel bait was applied to all rooms and that common areas were serviced as well. There are no noted observations of live roaches on the pest control documents. Based on interviews, file review, and observations conducted although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Facility staff do not ensure that residents' hygiene needs are met" it alleged that C2 and C4's hygiene needs are not being met as they are not bathing or showering. (6) of (6) Staff interviewed denied the allegation. (13) of (13) Clients interviewed could not corroborate the allegation. C2 refused to answer LPA's questions, but C4 stated they do shower when they want to and do their laundry when they want to. Staff interviews show that they are attentive to any clients who exhibit any strong body odor and will always remind and encourage clients to shower and care for their hygiene. File review of C2 and C4's file shows that the clients are able to care for their own grooming needs. They are able to care for all personal needs themselves which includes, showering, dressing, eating, and their own toilet needs. LPA did not observe the care plan for clients to include the staff assisting with showers. Based on interviews, file review, and observations conducted although the allegation may have happened or is 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: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC9099 (FAS) - (06/04)

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